Utilization Management Team Leader (RN)

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

About the Opportunity An established managed long-term care facility located in New York City is actively seeking a self-motivated and compassionate professional for a promising opportunity on their staff as a Utilization Management Team Leader. In this role, the Utilization Management Team Leader assists in the day-to-day activities and evaluation of utilization activities. Apply today! Company Description Managed Long-term Care Facility Job Description The Utilization Management Team Leader will: * Assist the Associate Director * Supervise the clinical and support staff responsible for Global Utilization review and monitoring * Support Member Care Management and utilization review activities in conjunction with Case Management/Utilization review teams * Support Utilization Management team development through direct staff training and development activities * Promote and facilitate a multidisciplinary approach to coordinate care and plan operations among disciplines * Conduct Utilization Review audits and quality of care monitoring activities including appropriateness of inpatient, skilled nursing facility and acute rehabilitation admissions, transitions of care, Behavioral Health and home health services * Participate in the development, implementation, and evaluation of quality improvement and performance improvement initiatives and other related projects within utilization management * Participate in committees ad assigned * Oversee that all Care Manager are following UM processes Required Skills * Active New York State Registered Nurse license * 2+ years of clinical experience in an acute care setting * Managed care case management and/or utilization management experience * Knowledge of the principals surrounding Case Management Standard of Practice * Experience using Interqual Guidelines * Strong communication skills * Highly organized * Ability to multitask Desired Skills * BSN * 2 years of experience * Case Management Certification