adecco medical & science is seeking a remote nurse for our utilization management manager role.
the utilization management rn will maintain state and federal regulatory compliance by processing prior authorization requests and hospital reviews timely and cost savings related to identification of appropriate utilization of health care services
primary responsibilities, but not limited to:
oversight of medical necessity determinations for ltss long term support and services
support clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
engage in collaborations with case management and coordination of care, supporting service coordinator team members in the field
takes lead role in setting direction and participating in developing new programs
sets team direction, resolves problems and provides guidance to members of the team
ensures team meets established performance metrics and performance guarantees
adapts departmental plans and priorities to address business and operational challenges
plans, organizes, and oversees staff to ensure timely completion of assessments
oversees the department's daily staffing requirements to meet program standards
implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
other duties as assigned to support team
required qualifications:
current, unrestricted rn license in the state of minnesota
2+ years of rn experience of in a hospital setting, acute care, direct care case management, home health care or clinical experience in acute / rehab / or long – term care setting
1+ utilization management experience
1+ years of experience working with members who are enrolled in a minnesota health care program (msho, msc+, snbc)
1+ years of experience addressing health inequities within a health plan, clinical practice or in a community setting
intermediate skills with ms office including word, excel and outlook with proficient ability to navigate in a windows environment
preferred qualifications:
bsn
experience in managed care
medicare and / or medicaid experience
case management experience
experience with discharge planning
experience in utilization review, concurrent review and / or risk management
why work for adecco:
weekly pay
401(k) plan
skill training
excellent medical, dental and vision benefits
equal opportunity employer/veterans/disabled
the company will consider qualified applicants with arrest and conviction records
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United States, Minneapolis ,Minnesota
2022-09-20
2022-10-20
2086882
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