Manager- Utlization Review- Case Management

4 weeks ago


New York, United States American Consultants Full time
Job DescriptionJob Description

Manager- Utilization Review/Case Management- NY

American Consultants is looking for a permanent Manager of Utilization Review/Case Management for a facility in New York.

Description:

  • Assists the Director in overseeing the Utilization Management program within the hospital provided direct oversight for the Medical Necessity/Level of Care Program and the Denials Management program, assuring compliance with all the federal and state regulations.
  • Provides superior customer service by modeling the We Care standards.
  • Assists the Director with providing direction and supervision in performance standards, expectations, and productivity for each staff member.
  • Implements system performance process as necessary and completes annual performance appraisals.
  • Provides leadership, coaching, conflict resolution related to Utilization Manager Program goals and processes and supports to the personnel within area of supervision as well as those involved within Case Management.
  • Fosters relationships with payors and facilitates communication between hospital and payor as appropriate.
  • Utilizes data, trends, and reports to proactively identify opportunities to improve processes and practice.

Qualifications:

  • Bachelors in Nursing required
  • Minimum 3-5 years relevant clinical medical surgical, ICU or ER experience preferred.
  • HC-PRI Certified and PRI screen preferred. CCM Certification preferred
  • Current NYS RN License required
  • Membership in a professional organization preferred. Qualities that include effective written and verbal communication skills, decision-making and problem solving skills and comprehensive assessment skills




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