Jobs
>
New York City

    UM Supervisor, Care Review - New York, United States - Molina Healthcare

    Molina Healthcare
    Molina Healthcare New York, United States

    4 weeks ago

    Default job background
    Description


    JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.

    HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

    We are seeking a Registered Nurse with previous UM and inpatient experience along with knowledge of the NYS Medicaid guidelines.

    Previous leadership experience highly preferred. The candidate must be able to work in a high-volume environment. Further details to be discussed during our interview process. Remote position in New York. Work schedule Monday
    • Friday 8:00 AM to 5:00 PM EST with rotating weekend and holiday coverage 2 hour shifts.

    KNOWLEDGE/SKILLS/ABILITIESOversees an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.

    Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.

    Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.

    Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Care for Molina members.

    Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

    Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.

    Completes staff quality audit reviews.

    Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.

    Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.
    JOB QUALIFICATIONSRequired EducationGraduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
    Required Experience3+ years clinical nursing experience.2+ years utilization management experience.
    Experience demonstrating leadership skills.
    Required License, Certification, AssociationActive, unrestricted State Registered Nursing (RN) in good standing.

    Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

    New York RN licensePreferred EducationBachelor's or Master's Degree in Nursing, Health Care Administration, Public Health or related field.

    Preferred Experience5 years clinical practice with managed care, hospital nursing or utilization management experience.3+ years supervisory experience in a managed healthcare environment.

    Utilization management, inpatient preferredKnowledge of NYS Medicaid guidelinesPreferred License, Certification, AssociationActive, unrestricted Utilization Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.


    To all current Molina employees:
    If you are interested in applying for this position, please apply through the intranet job listing.
    Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


    Pay Range:
    $59, $129,589.63 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


    Job Type:
    Full Time Posting Date: 04/23/2024
  • Molina Healthcare

    Um Care Review Clinician Inpatient Review

    1 week ago

    Molina Healthcare Bronx, United States

    Job Summary · Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high ne ...

  • AltaStaff, LLC

    care review clinician i

    3 weeks ago

    AltaStaff, LLC , NY, United States

    AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client · Pay Rate: $ $39.00 hourly · Shift: Monday - Friday, 8 hour shifts · ***This is a fully remote role but candidates must be licensed in NY*** · Summary: This role w ...

  • Molina Healthcare

    UM Supervisor, Care Review

    3 weeks ago

    Molina Healthcare New York, United States

    JOB DESCRIPTION · Job Summary · Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for m ...

  • Professional Management Enterprises

    Care Review Clinician I

    3 weeks ago

    Professional Management Enterprises New York, United States

    Job Description · Job DescriptionSeeking a Care Review Clinician (RN, LPN or LVN - MUSTBE LICENSED IN NY STATE ) to work with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed ...

  • Princeton Review

    Medical & Health Care Admissions Reviewer

    1 week ago

    Princeton Review New York, United States

    A Medical and Health Care Admissions Reviewer on The Princeton Review's Medical Admissions Counseling (MAC) team is a professional editor and writer who crafts material for others, taking a student's vision, story or idea and creating a polished, publication-quality product that ...

  • APN Consulting, Inc

    Healthcare - Care Review Clinician I

    4 days ago

    APN Consulting, Inc New York, United States

    Job Title: Healthcare - Care Review Clinician I · Location: Remote (Must possess NY Nursing License) · Duration: 6 Months · Job Description: · Work Location (i.e., onsite or remotely based): · Remote-based but candidates can be located anywhere in the US but must be licensed in ...

  • VNS Health

    Medical Director

    3 days ago

    VNS Health New York, United States Full time

    Overview · Provides clinical expertise and guidance to the daily operations and administration of medical management for VNS Health Plans. Assists senior leadership in planning, directing and coordinating all medical and related activities. Participates in implementing standards ...

  • VNS Health

    Quality Improvement Specialist, Clinical

    3 days ago

    VNS Health New York, United States Full time

    Overview · Leads interdepartmental quality improvement activities such as development and engagement, clinical review, clinical risk management, and patient satisfaction. Serves as a resource to quality improvement committees and work groups. Analyzes outcome reports. Implements, ...

  • Mount Sinai

    Case Manager Rn-mount Sinai West- Full Time- Days

    2 weeks ago

    Mount Sinai New York, United States Full time

    **Description** · The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and Observation ( RETU) patients to determine the correct Level of care ( LOC), appropriateness of the admission and continued ...

  • VNS Health

    Medical Director

    2 days ago

    VNS Health New York, United States Full time

    Overview · Embark on a dynamic journey as the Medical Director at VNS Health Plans, where every day brings new challenges and opportunities to make a difference in healthcare Your role is more than just administration; it's about pioneering medical management strategies that rede ...

  • Social Work p.r.n.

    Utilization Review Clinician, Advocate, Virtual

    3 weeks ago

    Social Work p.r.n. New York, United States

    Utilization Review Clinician/Advocate needed for full-time, permanent, remote position. · **Position Responsibilities**: · ?Performs telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatme ...

  • VNS Health

    UAS RN

    3 weeks ago

    VNS Health New York, United States Full time

    Overview · Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans pol ...

  • NYU Langone Health

    Care Manager

    2 weeks ago

    NYU Langone Health New York, United States

    **NYU Langone Health** is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's h ...

  • VNS Health

    Quality Review Manager

    3 days ago

    VNS Health New York, United States Full time

    Overview · Conducts daily reviews of case files, letters, and database records against required criteria. Ensures compliance with VNS Home care policies and procedures, regulatory requirements and business practices up to an including contractual arrangements with payers. Prepare ...

  • VNS Health

    Clinical Evaluation Manager

    3 days ago

    VNS Health New York, United States Full time

    Overview · Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare ...

  • WellSpan Health Services

    Him Coder Iii

    3 weeks ago

    WellSpan Health Services York, United States

    **Schedule** · Full-time: 40hrs/week · Schedule: Monday - Friday, day shift · Work from home · **General Summary** · Collects, reviews, retrieves and codes data by careful review and analysis of documentation of inpatient medical records, assigning the appropriate ICD-10 codes fo ...

  • NYC Health + Hospitals

    Chart Abstractor

    3 weeks ago

    NYC Health + Hospitals New York, United States

    **About NYC Health + Hospitals** · **Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible** · NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to ...

  • VNS Health

    Quality Improvement Specialist, Clinical

    2 weeks ago

    VNS Health New York, United States Full time

    Overview · Leads interdepartmental quality improvement activities such as development and engagement, clinical review, clinical risk management, and patient satisfaction. Serves as a resource to quality improvement committees and work groups. Analyzes outcome reports. Implements, ...

  • NYC Health + Hospitals

    Staff Nurse

    3 weeks ago

    NYC Health + Hospitals New York, United States

    **About NYC Health + Hospitals**: · NYC Health + Hospitals/McKinney provides high quality short-term rehabilitation and long-term skilled nursing care in a comfortable person-centered setting. The McKinney Team commit themselves to the delivery of compassionate, comprehensive ser ...

  • VNS Health

    RN Field Supervisor-Partners-MLTC-Manhattan

    3 weeks ago

    VNS Health New York, United States Full time

    Overview · Monitors and assesses the delivery of home health field services. Supervises the activities of the field Home Health Aides (HHA). Provides case management support, clinical intervention, development of care plan and follow up as needed. Works under general supervision. ...