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Supervisor of Utilization Management
3 months ago
Supervisor of Utilization Management - Concurrent Review
VillageCareMAX
112 Charles Street, New York, NY 10014
VillageCare is looking for a motivated RN for our Supervisor of Utilization Management - Concurrent Review opening. This role is responsible for the oversight of concurrent review and discharge planning process for members with inpatient and skilled nursing facility stays. Training, mentoring, and monitoring work process and output will be essential to this role.
Some daily responsibilities will include:
- Supervise staff to ensure concurrent and post reviews for inpatient acute care, skilled and long-term care facilities are completed in a timely manner.
- Reconcile inpatient and SNF census daily, addressing any discrepancies.
- Ensure daily assignments are completed at the close of the day.
- Facilitate inpatient and discharge planning rounds on a weekly basis.
- Ensure that Interqual Guidelines or other criteria adopted by the VCMAX are appropriately applied to inpatient reviews.
- Review complex cases and authorizations of services with Medical Director.
- In collaboration with the medical management team develop and implement projects, systems, programs, policies, and procedures.
- Assist UM and Care Management Team to prepare for audits and other regulatory activities
- Conducts orientation and training related to Concurrent Review Unit functions for all VCMAX staff, including the development and maintenance of training materials, in conjunction with the Training and Development team.
We would like to speak to those who have a current and unrestricted New York State RN license. Bachelor's degree in Nursing required, advanced degree preferred. 2 years of utilization review experience at a Managed Care Organization or Health Plan required. Supervisory experience required. Knowledge of Medicaid and/or Medicare regulations along with ability to apply Interqual Care Guidelines will be essential to this role. URAC/CCM certifications preferred.
There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you
- PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts
VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.
VillageCare is an Equal Opportunity Employer.
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