UTILIZATION REVIEW MANAGEMENT SUPERVISOR & CASE MANAGEMENT

UTILIZATION REVIEW MANAGEMENT SUPERVISOR & CASE MANAGEMENT

(Multiple openings)

 

Our client in the Anaheim, California area is currently looking to fill a Utilization Review Supervisors position.

 

RESPONSIBILITIES:

 Train and develop utilization review staffSupervises a team of nurses ensuring prompt, cost effective, courteous and all legal requirement are providedEnsure objectives, standards, policies and procedures are metEnsure staff adheres to quality assurance and productivity standardsPerforms active customer service function for accounts, provides day to day contact with customers in resolving service delivery issuesInterviews, hires and establishes staff performance development plans, conduct staff performance reviews

 

REQUIRED:

 BS/BS from accredited college or universityRN License requireCPUR or other related designation requiredMinimum 5 years clinical practice experienceMinimum 2 years supervisory experience Strong knowledge of utilization review practicesExpert knowledge of the insurance industry and claim processingAcquired knowledge of GM claims process, plan design and customer needsComputer proficientSalary $70,000-$120,000

 

 

For immediate consideration forward a Word copy of your resume to Shannon@medpropersonnel.com

 

Or

 

Call 800-737-3101

 

REFERRAL BONUS AVAILABLE!


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SECOND OPENING

 

 

NURSE CASE MANAGER (Multiple Openings)

 

Our client a fast growing company in the Southern California area is currently looking to fill multiple positions in their facilities. 

 

RESPONSIBILITIES:

 Performs care management for members with complex and chronic care needs through assessment, development, implementation, coordination, monitoring and evaluating care plans designed for optimizing the  members health care Conducts assessments to identify individual needs and specific care management plansImplements care plans by facilitating authorizations, referrals within benefits structureCoordinates internal and external resources meeting identified needsMonitors and evaluates effectiveness of care management plansNegotiates rates of reimbursement

REQUIRED: 

 

BA/BS in a health related field and licensure as a health professional or certification as a care manager, or current unrestricted RN licenseMinimum 5 years clinical experience and/or a combinationKnowledge of care management assessment techniquesMinimum of 3 year experience in home health or discharge planning preferredMust have strong oral, written and interpersonal communication skillsProficient PC skills

 

SALARY:  Based upon experience  Mid $60,000 to High $80,000