Supervisor of Utilization Management

Village Care•New York, NY

About The Position

VillageCare is looking for a motivated RN for our Supervisor of Utilization Management - Concurrent Review opening. This role is responsible for the oversight of concurrent review and discharge planning process for members with inpatient and skilled nursing facility stays. Training, mentoring, and monitoring work process and output will be essential to this role. Some daily responsibilities will include: Supervise staff to ensure concurrent and post reviews for inpatient acute care, skilled and long-term care facilities are completed in a timely manner. Reconcile inpatient and SNF census daily, addressing any discrepancies. Ensure daily assignments are completed at the close of the day. Facilitate inpatient and discharge planning rounds on a weekly basis. Ensure that Interqual Guidelines or other criteria adopted by the VCMAX are appropriately applied to inpatient reviews. Review complex cases and authorizations of services with Medical Director. In collaboration with the medical management team develop and implement projects, systems, programs, policies, and procedures. Assist UM and Care Management Team to prepare for audits and other regulatory activities Conducts orientation and training related to Concurrent Review Unit functions for all VCMAX staff, including the development and maintenance of training materials, in conjunction with the Training and Development team.

Requirements

Must live in NJ/NY/CT
Current and unrestricted New York State RN license.
Bachelor's degree in Nursing required, advanced degree preferred.
2 years of utilization review experience at a Managed Care Organization or Health Plan required.
Supervisory experience required.
Knowledge of Medicaid and/or Medicare regulations along with ability to apply Interqual Care Guidelines will be essential to this role.

Nice To Haves

URAC/CCM certifications preferred.

Responsibilities

Supervise staff to ensure concurrent and post reviews for inpatient acute care, skilled and long-term care facilities are completed in a timely manner.
Reconcile inpatient and SNF census daily, addressing any discrepancies.
Ensure daily assignments are completed at the close of the day.
Facilitate inpatient and discharge planning rounds on a weekly basis.
Ensure that Interqual Guidelines or other criteria adopted by the VCMAX are appropriately applied to inpatient reviews.
Review complex cases and authorizations of services with Medical Director.
In collaboration with the medical management team develop and implement projects, systems, programs, policies, and procedures.
Assist UM and Care Management Team to prepare for audits and other regulatory activities
Conducts orientation and training related to Concurrent Review Unit functions for all VCMAX staff, including the development and maintenance of training materials, in conjunction with the Training and Development team.