The Director of Utilization Review oversees and develops clinical services including utilization review, peer reviews, case management and quality assurance.
Director of UR manages day-to-day operations of all the Utilization Review nursing staff, intake and support staff. Supervision and development of UM nurses (remote and local), intake and support staff Reviewer coordination and relation.
Scheduling, planning and delivery of services Delivery of quality of UR Services Maintains client contractual compliance and Utilization Review Accreditation Committee (URAC) compliance.
Development processes, policies Procedures within the department Manages continuous improvement in the quality of care and service provided Review all reviews for appropriate documentation and turn-around time Responsible for reporting the appeal and denials and back up for the denial and appeal log Auditing denial / appeals and log on a monthly basis Make recommendations regarding : staffing, training, CEU opportunities and allocation of resources Annual performance evaluations of organizational staff Collaborates with other departments within the organization for ongoing collaboration Assist with delegation and resolution of complaints Assist with development and coordination of quality program Collaborates with other departments and serves as a liaison to improve communication and customer service Job Requirements Current RN / BSN / BA in Nursing and / or Business Healthcare ManagementAt least 5 years experience in Utilization Management, Case Management and / or Quality ManagementCCM, ABQURARP or other UR designation preferredAt least 5 years clinical experiencePC literate, including Microsoft Office productsLeadership / management / motivational skillsStrong organizational skillsExcellent interpersonal skillsExcellent negotiation skillsAbility to work in a team environmentAbility to travelAbility to meet or exceed Performance Competencies
Registered Nurse Utilization Review - Monday - Friday 2pm-10:30pm
Minimum of 5 years of experience to include 2 years of clinical experience and minimum of 3 years of recent Utilization Review experience. Admission reviews are done concurrently at the point of entry in collaboration with ED and admitting physician and the cooperation with the access management tea...
Director of Utilization Review
Development processes, policies Procedures within the department– Manages continuous improvement in the quality of care and service provided– Review all reviews for appropriate documentation and turn-around time– Responsible for reporting the appeal and denials and back up for the denial and appeal ...
Registered Nurse Utilization Review - Part Time Saturday & Sunday 8:00 Am - 6:30 Pm
Minimum of 5 years of experience to include 2 years of clinical experience and minimum of 3 years of recent Utilization Review experience. Admission reviews are done concurrently at the point of entry in collaboration with ED and admitting physician and the cooperation with the access management tea...
Registered Nurse (RN) - Wound Ostomy & Continence - WOCN Certified - PRN
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