Manager RN Utilization Management - Remote Kentucky

Profile

Description

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications


Bachelor's Degree OR 4 years equivalent experience (See below experience requirements)
Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction.
2 years of management/leadership, project lead or subject matter expert
2 Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
1 year Utilization Management experience in an acute care, skilled or Rehabilitation clinical setting
6 years Technical experience aptitude to troubleshoot and resolve system platform and connectivity problems
Strong Proficiency with MS Office Suite to include Word, Excel, Power Point,
Experience with the development and implementation of policies and procedures
Ability to work independently under general instructions and with a team


Additional Requirements


Hours: Typically Monday-Friday 8:00 AM - 5:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.
Location: WAH Kentucky


Preferred Qualifications


Prior supervisory experience hiring, training, coaching, and termination
Health Plan experience
Medicaid experience
Bilingual is a plus


Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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