Looking for a Registered Nurse with leadership and utilization review experience to work with a large health plan overseeing utilization review nurses in the department.
RN Supervisor, Utilization Management Job Duties:
Oversees an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management activities aimed at providing members with the right care at the right place at the right time.
Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.
Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.
Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long Term Care for members.
Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.
Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.
utilization review, case management, concurrent review, discharge planning, care management, managed care, medicare, medicaid, utilization management, health plan, health care, managed healthcare, MBA, MSN, BSN, UR, Quality Improvement, Quality Assurance
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A-Line Staffing began in 2004 with just two of us – a father and son with 30 combined years of experience started the company out of a basement in Warren, Michigan. We started our company with just one placement, and continue to build the company and our relationships – one placement at a time.