Utilization Management Supervisor (RN)

Oversee the daily pre-authorization process for Palliative and Hospice clients

Job #2020-0005 Location: New York City Salary: very competitive compensation package

As Utilization Management Supervisor, you will review data to monitor regulatory requirements (standard/expedited time frames, organizational determination outcomes and communication, inter-rater reliability), provide direction for complex cases, monitor pending cases, review and educate staff on new criteria trends (including Interqual, local carrier policy, national coverage determinations), and act as a liaison with interdepartmental communication.

Qualifications include:

  • Graduate of an accredited nursing program: BS/BSN preferred
  • Previous managed care experience in the area of utilization management and/or care management
  • Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health, with 1-3 years of management experience that includes a working knowledge case management and utilization management processes
  • Working knowledge of Windows, Word, Excel and clinical care management software
  • Current NYS RN license
  • CCM preferred
  • Excellent clinical assessment and disease management skills
  • Knowledge of current standards of medical practice and healthcare delivery systems
  • Knowledge of Interqual preferred
  • Knowledge of Federal and State regulatory requirements for managed care
  • Knowledge of principles and concepts of CQI methodologies