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
