Manager of Utilization Management
Must have working knowledge of MS Office environment, and ability to function in highly computerized environment.
The Manager makes staff assignments. Evaluates staff and determines the quality of their work efforts.
Develops or assists in the development of related prior authorization and claims policy, incorporating current literature and professionally recognized standards.
Develops or assists in development and implementation of policy and plans for effective patient centered utilization management and case management.
Develops and/or implements effective ongoing programs to measure, assess, and improve quality of processes and workflows, treatment, and services delivered to patients.
Develops productive work teams; recommends disciplinary actions; collaborates with clinical leadership for educational programs. compiles data and prepares periodic reports; responsible for coordinating and providing appropriate coverage.
Maintains contacts with individuals both within and outside of the department who might impact program activities.
Assures optimal quality of care and service is provided.
Participates in Quality Assurance Programs as needed; intervenes in crisis situations and investigates all unusual incidents.
Leads and participates in meetings; may speak on behalf of department.
Management level experience including but not limited to: staff oversight, program management, and issue resolution.
Active RN or LVN
Minimum of 5 years’ recent clinical experience.
Minimum of 3 years’ experience in IPA or managed care setting preferred.
Experience supervising staff and monitoring productivity/performance required.
Prior experience with project development and implementation.
Must have excellent communications skills both verbally and written.
Project Management experiences a plus.
Active and unrestricted Registered Nursing license
Please apply at:
OnDemand Employment Group
2011 Auto Center Drive #116
Please bring with you 2(two) forms of valid identification and an updated resume.