Utilization 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 nonprofit healthcare organization in New York City is actively seeking a licensed Registered Nurse (RN) for a promising Utilization Management Manager position with their growing staff. In this role, the Utilization Manager will be responsible for overseeing and assisting the 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 Organization Job Description The Utilization Management Manager (RN) will be responsible for: * Reviewing specific utilization or care management issues with the Interdisciplinary team * Investigating, analyzing and reporting to Medical Management leadership * Monitoring care or utilization management processes with the Clinical Evaluation Managers (CEM) and the Interdisciplinary team * Ensuring compliance with regulatory requirements and achievement of audit targets * Collaborating with clinical specialties and Care / Utilization Management staff in the planning and implementation of the models of care * Ensuring that ongoing care /utilization management is provided by staff * Participating in development and implementation of the Quality Assurance and Compliance initiatives * Working with the Director of Medical Management * Acting as resource for the CEM staff and facility discharge planning staff Required Skills * 4+ years of experience in Home Care, Care Management or related field; 3+ years of progressive experience in Case or Utilization Management * Bachelor's Degree or equivalent work experience in Management for a Health Plan or Utilization / Case Management * NYS Registered Nurse (RN) license * 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 * Master's Degree in Nursing or Health Care Administration * Case Management Certification