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    Utilization Review Manager - New York, United States - Tandym Group

    Tandym Group
    Tandym Group New York, United States

    4 weeks ago

    Tandym Group background
    Description

    A growing health services network in New York is currently seeking an experienced, licensed Registered Nurse (RN) to join their Case Management team as a Utilization Review Manager. In this role, the Utilization Review Manager (RN) will be responsible for assisting the Director of Case Management in overseeing the Utilization Management Program.

    About the Opportunity:

    • Schedule: Monday to Friday
    • Hours: 8:30am to 5pm
    • Specialty: Case Management

    Responsibilities:

    The Utilization Review Manager (RN) will:

    • Provide direct oversight for the Medical Necessity/Level of Care Program and the Denials Management Program, assuring compliance with all Federal and State regulations
    • Assist the Director with providing direction and supervision in performance standards, expectations and productivity for each staff member
    • Implement system performance process as necessary and completes annual performance appraisals
    • Provide leadership, coaching, conflict resolution related to Utilization Management Program goals and processes
    • Provide support to the personnel within area of supervision as well as those involved within case management
    • Foster relationships with payors and facilitates communication between hospital and payor as appropriate
    • Utilize data, trends and reports to proactively identify opportunities to improve processes and practice
    • Perform other duties, as needed

    Qualifications:

    • 3+ years of Clinical experience
    • Bachelor's Degree in Nursing
    • NYS Registered Nurse (RN) license
    • Managed Care experience with Utilization Review and Discharge Planning

    Desired Skills:

    • Certified in Case Management
    • PRI
    • Experience in a Emergency Room, Intensive Care, and/or Medical-Surgical setting
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