Field Clinical Evaluation 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 nonprofit healthcare company in New York City is actively seeking a licensed Registered Nurse (RN) for a promising Field Clinical Evaluation Manager position with their growing staff in the Bronx. In this role, the Field Clinical Evaluation Manager (RN) will be responsible for assessing member needs and identifying solutions that promote high quality and cost effective health care services. Apply today! Company Description Nonprofit Healthcare Company Job Description The Field Clinical Evaluation Manager (RN) will: * Conduct comprehensive review of all components related to requests for services * Perform in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member's needs * Perform in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan * Examine standards and criteria to ensure medical necessity and appropriateness of service, admissions, and lengths of stay * Identify opportunities for alternative care options and contributes to the development of a safe member centered service plan * Maintain current knowledge of organizational or state wide trends that affect member eligibility and the need for issuance of Notices of Action * Evaluate and analyze utilization trends / issues and identify opportunities for better coordination of member service * Participate in approval for out-of-network services when member receives services outside of the company's network services * Participate in special projects and perform other duties, as assigned Required Skills * 3+ years of Case Management, Home Care, and/or Managed Care experience * Associate's Degree in Nursing * NYS Registered Nurse (RN) * Utilization Review background * Previous Medicaid / Medicare, Managed Long-Term Care and/or UAS experience * Solid assessment, clinical, and documentation skills * Patient oriented * Great interpersonal skills * Excellent communication skills (written and verbal) * Strong attention to detail * Highly organized Desired Skills * Bachelor's and/or Master's Degree in Nursing