Oversee the daily pre-authorization process for Palliative and Hospice clients
Job #2020-0005 Location: New York City Salary: very competitive compensation package As Utilization Management Supervisor, you will review data to monitor regulatory requirements (standard/expedited time frames, organizational determination outcomes and communication, inter-rater reliability), provide direction for complex cases, monitor pending cases, review and educate staff on new criteria trends (including Interqual, local carrier policy, national coverage determinations), and act as a liaison with interdepartmental communication.
Qualifications include:
Graduate of an accredited nursing program: BS/BSN preferred
Previous managed care experience in the area of utilization management and/or care management
Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health, with 1-3 years of management experience that includes a working knowledge case management and utilization management processes
Working knowledge of Windows, Word, Excel and clinical care management software
Current NYS RN license
CCM preferred
Excellent clinical assessment and disease management skills
Knowledge of current standards of medical practice and healthcare delivery systems
Knowledge of Interqual preferred
Knowledge of Federal and State regulatory requirements for managed care
Knowledge of principles and concepts of CQI methodologies
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