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 growing nonprofit healthcare organizaton located in New York City is actively seeking a compassionate and dedicated Registered Nurse (RN) for a promising opportunity on their staff as a Clinical Evaluation Manager (RN). In this role, the Clinical Evaluation Manager (RN) assesses member needs and identifies solutions that promote high quality and cost effective health care services. Opportunities are available in Manhattan, Brooklyn, and Queens. Apply today! Company Description Nonprofit Healthcare Organization Job Description The Clinical Evaluation Manager (RN): * Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary * Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment * Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan * Examines standards and criteria to ensure medical necessity and appropriateness of service, admissions, and lengths of stay * Uses effective standards of review, service determination, resource management, education and related interventions to promote improved quality of care and/or life * Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan * Issues request determinations, including Notice of Action letters, and other forms of communication to members and providers * Maintains current knowledge of organizational or state wide trends that affect member eligibility and the need for issuance of Notices of Action * Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are documented and saved in the member's record * Evaluates and analyzes utilization trends/issues and identifies opportunities for better coordination of member services Required Skills * ASN * Active New York State Registered Nurse license * Prior experience in a Managed Long Term Care or UAS * Patient-oriented * Ability to multitask Desired Skills * BSN / MSN * 2+ years of experience