Utilization Management Supervisor

1 week ago


New York, United States HealthSearch Group Full time

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

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