Utilization Management RN
1 week ago
Contract to Hire position
Job Category Insurance Professional & Clinical
Job Title Utilization Management RN
Job Description
The candidate MUST have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.. The candidate MUST have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA..
Responsibilities include but not limited to:
- Performs audits and conducts ongoing monitoring of delegated entities to ensure compliance with federal and state laws, accreditation standards
- Reviews materials submitted, including policies, files, program documents and other materials relevant to the audit
- Conducts analysis of data related to vendor performance, and identifies opportunities for improvement
- Writes audit reports, manage corrective action plan
- Presents findings and recommendations to the Delegation Oversight Committee
- Conducts annual risk assessment that identifies and evaluates delegation risk
- Collects and prepare documents in preparation for audits.
- Actively participates in CMS program audits
- Knowledge of Part C Organization Determination guidelines and National Committee for Quality Assurance (NCQA) standards
Our Story: We’re Not New Kids On The Block. We started Open Systems Technologies because we wanted to reinvent hiring. Entrepreneurship is still at the core of what we do. For the past three decades, we have nurtured relationships with job seekers and employers from coast to coast.
We have grown in size and revenue to become one of the largest privately-owned staffing firms in the United States. Hard work and ingenuity have allowed us to turn our passion for technology into a thriving business.Company DescriptionOpen Systems Technologies: We believe in finding people first then finding them jobs. It's not about giving people "a" job; it's about identifying opportunities and asking them which one they want. Our greatest motivation is knowing that we can make your life hassle-free with services and opportunities we are proud to provide.\r
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Our Story: We’re Not New Kids On The Block. We started Open Systems Technologies because we wanted to reinvent hiring. Entrepreneurship is still at the core of what we do. For the past three decades, we have nurtured relationships with job seekers and employers from coast to coast.\r
\r
We have grown in size and revenue to become one of the largest privately-owned staffing firms in the United States. Hard work and ingenuity have allowed us to turn our passion for technology into a thriving business.
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