Lead Utilization Management Nurse (77166)
About The Position
Centurion is the provider of comprehensive healthcare services to the Missouri Department of Corrections. This full-time Lead Utilization Management Nurse position is located at the MO Regional Office in Jefferson City, Missouri. The role involves managing and supporting the utilization management review process and centralized scheduling programs within a statewide contract. The Lead UM Nurse provides support and direction to the UM Team and assists staff with processes and documentation for the statewide evidence-based utilization management review program. This professional engages in prospective, concurrent, and retrospective reviews, complex case management, and ensures continuity of quality medical services, including office, hospital, free-standing diagnostic, specialty care, surgical, and inpatient services. The role also contributes to the evaluation of the UM program and staff through data review, inter-rater reliability, and other standard program evaluation tools.
Requirements
- Bachelor's degree in nursing or related field
- Registered Nurse (RN) license
- Minimum of five (5) years of experience in utilization management, case management, disease management, health information management, nursing management, healthcare quality monitoring/auditing, or related field
- Ability to pass background investigation and obtain agency security clearance
Nice To Haves
- Master's degree in nursing or related field
- Medical management, case management, disease management, quality management, or CCHP certification
- Knowledge of statistics, data collection, analysis, and data presentation
- Experience working with a correctional institution or agency
Responsibilities
- Manage and support the utilization management review process and centralized scheduling programs within a statewide contract
- Offer support and direction to the UM Team
- Assist staff in the processes and documentation associated with the statewide evidence-based utilization management review program
- Engage in prospective review
- Engage in concurrent review
- Engage in retrospective review
- Engage in complex case management
- Ensure continuity of quality medical services to include office, hospital, and free-standing diagnostic services, specialty care services, surgical services, and inpatient care
- Contribute to the evaluation of the UM program and staff through review of data, inter-rater reliability, and other standard program evaluation tools
Benefits
- Health, dental, vision, disability and life insurance
- 401(k) with company match
- Generous paid time off
- Paid holidays
- Flexible Spending Account
- Continuing Education benefits
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Number of Employees
501-1,000 employees
