Clinical Utilization Nurse
2 weeks ago
As a key member of Cantex Continuing Care Network, the Utilization Management Nurse plays a vital role in overseeing the clinical coordination and leadership of the Utilization Management, Referral, and Precertification Management processes. This position serves as a crucial link between the Utilization Management/Case Management department and healthcare providers.
Key Responsibilities:
- Conduct thorough clinical evaluations of data and manage all reporting related to Utilization Management.
- Oversee the intake data reporting process, ensuring accuracy and compliance.
- Supervise daily operations of the Utilization Management/Intake department, ensuring optimal resource utilization.
- Identify and implement process improvements to enhance departmental efficiency.
- Provide education and training to staff to maintain high performance standards.
- Collaborate with the UM Manager and Director to facilitate system processes with external partners.
- Manage and mentor a team of Intake Coordinators and Clinical UM Staff, monitoring productivity and caseload distribution.
- Prepare comprehensive Utilization Management reports and clinical analysis documents as required.
- Ensure adherence to Health Insurance Portability and Accountability Act (HIPAA) regulations.
Qualifications:
- Bachelor's degree in Nursing, Social Work, Counseling, Psychology, or a related clinical field is required; a Master's degree is preferred.
- A minimum of 3 years of experience in utilization management or quality improvement.
- Strong understanding of utilization management principles and quality improvement methodologies.
- Prior experience in a leadership role managing cross-functional teams is highly desirable.
- Two years of clinical experience in a hospital setting is required.
- Active, unrestricted State Nursing license (RN) or Clinical Social Worker license in good standing.
Benefits:
- Competitive salary and wages
- 401k plan with company match
- Comprehensive medical, dental, vision, and supplemental insurance options
- Generous vacation, sick leave, personal holidays, and paid holidays
- Short-term disability and life insurance coverage
- Tuition and continuing education reimbursement
- Employee rewards and recognition programs
Cantex Continuing Care Network is dedicated to fostering a diverse and inclusive workplace that values the contributions of all individuals. We are committed to creating an environment that respects our differences and promotes equity in all aspects of our operations.
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