Medical Management Manager (RN)

The Execu|Search Group
Aug 13, 2017
Aug 14, 2017
Employer Type
Direct Employer
Employment Type
Full Time
Job Description:

About the Opportunity A New York City-based nonprofit healthcare agency is actively seeking a licensed Registered Nurse (RN) to join their growing staff as their new Medical Management Manager. In this role, the Medical Management Manager (RN) will be responsible for overseeing the Care Management or Utilization Management teams to ensure that standards for service delivery and team / staff performance are met or exceeded. Apply today! Company Description Nonprofit Healthcare Agency Job Description The Medical Management Manager (RN) will: * Review specific utilization or care management issues with interdisciplinary team, focusing on problem solving, early identification and response to actual or potential quality issues or complaints, approvals requiring next level authorization * Investigate, analyze and report to Medical Management leadership on the facts related to member complaints, incidents, or challenging member issues * Monitor care or utilization management processes with the Clinical Evaluation Managers (CEM) and the Interdisciplinary team to ensure cost effective quality outcomes * Ensure that ongoing care / utilization management is provided by staff through a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet members' health needs through communication and available resources * Participate in development and implementation of the Quality Assurance and Compliance initiatives and collaborates across team, regions and programs * Work with the Director of Medical Management to implement a set of high quality and cost effective member services provided by assigned staff or through contract relationships in both home and community-based settings. * Manage and evaluate staff in delivery and coordination of comprehensive care/utilization management in home and community * Generate care management reports via the care/utilization management systems * Handle other duties, as needed Required Skills * 4+ years of Home Care and/or Care Management experience; 3+ years of progressive experience in Case or Utilization Management * Bachelor's Degree in Nursing * NYS Registered Nurse (RN) license * Previous experience in a Management and/or Supervisory role * Utilization Review background * Solid assessment, clinical, and documentation skills * Patient oriented * Great interpersonal skills * Excellent communication skills (written and verbal) * Strong attention to detail * Highly organized * Able to multitask efficiently and effectively Desired Skills * Master's Degree in Nursing or Health Care Administration * Case Management certification