Manager- Utilization Review/Case Management- NY

American Consultants is looking for a permanent Manager of Utilization Review/Case Management for a facility in New York.

Description:

• Assists the Director in overseeing the Utilization Management program within the hospital provided direct oversight for the Medical Necessity/Level of Care Program and the Denials Management program, assuring compliance with all the federal and state regulations.
• Provides superior customer service by modeling the We Care standards.
• Assists the Director with providing direction and supervision in performance standards, expectations, and productivity for each staff member.
• Implements system performance process as necessary and completes annual performance appraisals.
• Provides leadership, coaching, conflict resolution related to Utilization Manager Program goals and processes and supports to the personnel within area of supervision as well as those involved within Case Management.
• Fosters relationships with payors and facilitates communication between hospital and payor as appropriate.
• Utilizes data, trends, and reports to proactively identify opportunities to improve processes and practice.

Qualifications:

• Bachelors in Nursing required
• Minimum 3-5 years relevant clinical medical surgical, ICU or ER experience preferred.
• HC-PRI Certified and PRI screen preferred. CCM Certification preferred
• Current NYS RN License required
• Membership in a professional organization preferred. Qualities that include effective written and verbal communication skills, decision-making and problem solving skills and comprehensive assessment skills