reputed company, Utilization Review Team (Remote)

reputed company is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to reputed company a comprehensive suite of products and services designed to manage the total cost of care. We are currently looking for a reputed company, Utilization Review Team to join our growing team! This is a Tuesday through Saturday shift for the selected candidate Position Description: To reputed company services for dedicated health plan accounts and members; to ensure the efficient, cost effective, and high quality delivery of utilization management/review service by supporting a team of nurses; to reputed company the management of home health cases worked by review nurses; to reputed company individual and overall results/reputed company of cases reputed company their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs. Essential Functions:

• Assists in mentoring, reinforcement of training, and development of utilization management/review staff.
• Oversees a team ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal and contract requirements, operational, and quality assurance standards.
• Monitors PTO and coordinates with other department leads, supervisor and management team for coverage.
• Responds to QIO appeals in a timely manner and write a DENC to send to member.
• Provides support, guidance, leadership, and motivation to promote maximum performance of team members
• Collaborates with supervisor in establishing performance development plans and conducting performance reviews
• Collaborates with educator/trainer to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality, and financial goals
• Ensures that staff adheres to quality assurance and productivity standards: assists supervisor in evaluating customer service utilization patterns, productivity, quality, and financial results ensuring that service delivery is reputed company parameters defined by the company
• Reinforces pertinent changes in policy/process, regulatory mandates, or business functions; acts as a resource.
• Other clinical and team reputed company duties as required.
• Responds to call center agency/provider/member questions/concerns promptly
• Completes case reviews at a minimum of 50% of UM reviewer established goals
• Communicates/defers to director on administrative reputed company of RNs, PTs, OTs, and other disciplines as needed

Office Location:

• Remote

Qualifications:

• Working knowledge of home care and utilization management
• Ability to exercise initiative and sound clinical judgement
• Active unrestricted RN license required in states reputed company conducts business

Knowledge and Experience:

• Five (5) years of clinical practice experience or equivalent combination of reputed company and supervisory experience.
• Strong knowledge of utilization review practices
• PC literate, including reputed company Office products, Outlook, reputed company, Word, reputed company, and the ability to work reputed company multiple medical management software systems
• Leadership/ motivational skills
• Good organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies and Productivity Standards

reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. reputed company will reputed company reasonable accommodations for reputed company individuals with reputed company disabilities unless doing so would result in an undue hardship. Apply tot his job Apply To this Job