Responsible for management of day-to-day operations of the Utilization Review department including evaluation of daily data capture, quality assurance, program implementation, training and management of staff to achieve performance improvement, revenue enhancement and meet the managed care objectives of the company. Manage the daily operational activities of the unit from UR referral receipt to closure. Assist in regulatory audit proceedings within the department including Utilization Review Accreditation Commission (URAC) and state agency audits. Conduct internal file audits to ensure quality UR outcomes.
Watch: Career Advice
RN license required. CCM Preferred.
Minimum 5 years prior operational experience in a managed care / healthcare environment and 1 year workers compensation experience. Advanced analytical and problem-solving skills. Advanced customer service skills. Advanced PC, organization and communication skills. Advanced interpersonal and multi-function staff management skills. Proficient knowledge of state jurisdictional and regulatory issues.
Send To A Friend
Posts
