Icon hamburger
US
What job do you want?
Apply to this job.
Think you're the perfect candidate?
Apply Now
Thumsup

You’re being taken to an external site to apply.

Enter your email below to receive job recommendations for similar positions.
A450129a02c4a4d7fa91ff071e31b2a5

Registered Nurse -Manager of Utilization Management

Nurse Resolutions Beaverton, OR Full-Time
$97,000.00 - $120,000.00 / year
Apply Now
  • Manage the operations and support team within Health Care Services including the Call Center, Utilization Management or Care Management intake & review functions which includes but is not limited to prior authorization, concurrent review (CCR), Claims, skilled nursing facility (SNF) Review and care management services.
  • Provide oversight and direction for systems and tools used internally by staff and externally by provider partners to assist in Medical or Care Management operations.
  • Achieves organizational performance standards for Call Center activities, prior authorization, CCR review, SNF review, Claims Audit, Care Management and other areas as deemed appropriate.
  • Prepares and manages budget for applicable area(s).
  • Manages coordination of all work, quality improvement activities, projects, objectives and staffing of the department by working with other Managers and Supervisors within Health Care Services.
  • Evaluates performance and initiates personnel actions such as hiring, merit increases, probationary and periodic reviews, promotions, work plans and disciplinary actions.
  • Bachelor’s degree in Nursing or other clinical bachelor degree equivalent.
  • Graduate from an accredited school of nursing or graduate from an accredited equivalent clinical program.
  • 3+ years of documented direct management or supervisory experience in a clinical or managed care setting.
  • 5+ years of clinical experience.
  • 2+ years of utilization, quality or care management experience in an insurance or managed care setting.
  • Formal education or training in supervision, management, or leadership and demonstrated experience in program planning, development and evaluation.
  • Proven knowledge of the management, operation, function and objectives of population based utilization and care management services for individual patients/members.
  • Expert customer service skills.
  • Strong project management skills with the ability to coordinate complex projects and build work plans to lead a group through implementation and execution of new projects and continuous process improvement projects.
  • Strong working knowledge of all pertinent regulatory and accrediting body requirements, specifically CMS, State Medicaid Programs, The Affordable Care Act and NCQA.
  • Working knowledge of CPT, HCPCS and ICD-9 & ICD-10 coding.
  • Demonstrated high level computer skills in MS Office Suite, Facets or other claims processing platforms, and Utilization Management or Care Management charting platforms
  • Demonstrated working knowledge of health care cost containment concepts and managed care principles.
  • Knowledge of medical benefits and medical/transplant network administration.

Recommended skills

Medicaid
Managed Care
Implantable Cardioverter Defibrillator
Utilization Management
Cpt Coding
Claims
Apply to this job.
Think you're the perfect candidate?
Apply Now

Help us improve CareerBuilder by providing feedback about this job: Report this job

Report this Job

Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to our Trust and Site Security Team

CAREERBUILDER TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.