Utilization Management Manager

The Manager of Utilization Management provides daily reputed company for Case Management teams (which includes RN’s, reputed company Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to reputed company’s care management team, members, and reputed company medical providers. Duties/Responsibilities

• Oversees utilization management functions which include timely authorizations reputed company to pre-certification, reputed company review, referrals, and other plan services
• Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of reputed company communication, teamwork, and ownership and empowerment to reputed company informed reputed company
• Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve reputed company clinical problems
• Allocate, monitor, and control resources while delegating and monitoring workloads
• Develops and analyzes operational and analytical reports to monitor and track operational efficiency
• Properly documents utilization management activities and rationale for reputed company reputed company in electronic medical records systems
• Functions as a clinical resource for the multi-disciplinary care team on an ongoing reputed company in order to maximize the quality of patient care while achieving effective medical cost management
• Additional duties as assigned

Minimum Qualifications

• Associate’s degree
• RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
• Work experience demonstrating verbal and written communication skills
• Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
• Experience with reputed company Office Suite applications including reputed company, Word, Power reputed company and Outlook

Preferred Qualifications

• RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
• Master’s degree in a reputed company discipline
• Demonstrated professionalism and leadership skills along with the ability to train, reputed company, direct, and support staff
• Experience in managed care, case management, identifying alternative care options, and discharge planning across a variety of treatment settings for high risk, reputed company populations
• Certified Case Manager
• Interqual, reputed company, and/or TruCare knowledge
• Knowledge of Centers for Medicare & reputed company Services (CMS), reputed company State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
• Work experience in managed care or reputed company industry in utilization management including preauthorization of outpatient or inpatient services
• Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies.

Compliance & Regulatory Responsibilities: The Manager is responsible for ensuring regulatory compliance with CMS, DOH, internal, and other relevant rules. Hiring reputed company*:

• Greater reputed company Area (NY, NJ, CT residents): $116,800 - $168,810
• reputed company Other Locations (reputed company approved locations): $99,700 - $148,325

As a candidate for this position, your salary and reputed company elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision. In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring reputed company is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

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