Care Manager - Utilization Review (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 premier managed long-term care facility located in New York City is actively seeking a self-motivated and compassionate Registered Nurse (RN) for a promising Utilization Review role on their staff. In this role, the Utilization Review Nurse will be primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. Apply today! Company Description Managed Long-Term Care Facility Job Description The Utilization Review Care Manager will: * Performs care management including hospital admission certification, continued stay review, discharge planning, out-patient and ancillary services review, etc. * Oversees the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner * Interacts and obtains relevant clinical information from member's PCP and other providers * Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms * Evaluates member needs for referred cases (from providers or member self-referred) * Assists all departments with the resolution of members' problems related to utilization management issues * Performs all Utilization Management activities in compliance with all regulatory agency requirements * Conducts medical record reviews as appropriate to case management functions * Participates in Medical Management grand rounds with the Physician Advisor Required Skills * Active New York State Registered Nurse license * 3-5 years of clinical experience in an acute care setting * Strong clinical skills and knowledge * Patient-oriented * Ability to multitask * Excellent communication skills * Strong interpersonal skills Desired Skills * BSN * UM/UR experience in managed care or hospital setting