Position Title: DIRECTOR OF UTILIZATION MANAGEMENT – NH

 

Relocation: MUST BE CLOSE ENOUGH TO DRIVE IN FOR AN INTERVIEW

 

Location: Salem, NH

 

JOB SUMMARY:

 

Manage Utilization Management services, oversee all aspects of Utilization Management to ensure efficiency of the workflow for team members, and ensure quality cost effectiveness.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

·       Work with Manager/Director of Quality to oversee quality improvement and assimilate results of Quarterly/Annual Reports, implementing changes if needed.

·       Available to provide training as needed to staff – some travel required.

·       Acts as primary contact for Managed Care Software issues - working with Managed Care Software Vendor in resolving Managed Care Software problems that cannot be resolved or with the assistance of MIS.

·       Coordinates training of new Utilization Management and Case Management.

·       Acts as a liaison with staff regarding medical necessity issues.

·       Oversees daily and weekly productivity of Utilization Review teams making suggestions to implement changes when needed.

·       Work with Vice-President to ensure compliance with all regulatory and accrediting associations including but not limited to staff licensing, company licensing, and company accreditations. (20%)

·       Communicates with team members the department’s objectives, standards, and expectations. Develops objectives and standards in conjunction with management.

·       Researches and resolves customer service problems regarding specific cases and/or policies. Communicates problems and resolution to management, other departments and callers.

·       Interview, hire, train, and develop assigned employees, and evaluate team members’ performance. Provide feedback whenever needed to employees and management.

·       Develop and implement clinical and operational policies and procedures. Review and update periodically.

·       Fiscal responsibility/accountability as outlined in the budgetary process.

·       Key contact for clients during implementation and upon completion of implementation of new Utilization Management clients.

 

EDUCATION AND/OR EXPERIENCE:

 

·       Current NH RN license.

·       College degree and/or nursing diploma.

·       3 plus years medical/surgical clinical experience.

·       3 plus years utilization review experience.

·       At least 3 years management/supervisory experience and demonstrated leadership/management skills in managed care.

·       Certification is nursing specialty preferred.

·       Additional coursework toward management certificate/diploma highly desired.

·       Membership in professional organization (i.e. ANA, AAMC) highly desired.

·       Conflict management/problem-solving skills.

·       Strong knowledge of organization and its goals and objectives.

·       Strong and effective written, verbal and interpersonal communication skills.

·       Able to work effectively with minimum supervision.

·       Effective use of time management skills.

·       Works well as a team player.

·       Able to provide direction to team members.

·       Highly organized self-starter.

·       Extensive knowledge of managed care software and automated systems.

·       Extensive knowledge of insurance industry, benefit design and coverage issues.

·       Able to manage multiple priorities.

 

BOTTOM LINE (MUST HAVE) REQUIREMENTS:

 

·       Current RN license.

·       College degree and / or nursing diploma.

·       3+ years medical / surgical clinical experience.

·       3+ years utilization review experience.

·       3+ years management / supervisory experience and demonstrated leadership / management skills in managed care.

·       Certification is nursing specialty preferred.

·       Membership in professional organization (i.e. ANA, AAMC) highly desired.

 

 

HOW TO APPLY:  

          

Send resume to: AnJ.Recruiting@gmail.com  ; mark attention of Albert (Al) Mercer.