|
Manager: Utilization Review, Pre-cert and Case Management
Working Group : Clinical Services
Reporting: Director of Clinical Services
Role:
This role is responsible for the direct oversight of utilization review, pre-certification and case management and all staff supporting those functions. The Manager works closely with the Director of Clinical Services, Director of Patient Services and the Medical Director to assure effective use of work guidelines and tools and delivery of quality services to our members, clients, providers and internal work groups.
Responsibilities/Tasks:
- Provide direct management and leadership to staff
- Ensure work flow compliance
- Monitor performance standards and tracks key performance indicators
- Develop work flows and logic rules related to assigned work group
- Assure staff is appropriately trained to perform job functions
- Ensures regulatory compliance standards for department are met
- Participate in projects as needed
- Provides clinical resource information for internal and external customers
- Continually evaluates services for care coordination opportunities
Skills/Education:
- Licensed Registered Nurse
- Bachelors degree, or higher preferred
- Certification in Case Management desired
- Experience in managed care desired
- Minimum of 5 years clinical experience
- Minimum of 3 years management experience
- Possess excellent verbal and written communication skills
- Self Directed
- Able to function in team environment where role blending occurs
Send us your resume
|
