Manager of Concurrent Review

POSITION SUMMARY:

 

The Manager for Concurrent Review is primarily responsible for the Concurrent Review  activities, clinical and non-clinical staff. This position is responsible for the daily staffing and functioning of the concurrent review services at Bravo Health.  Also responsible to develop and maintain strong working relationships with all providers, facilities and internal departments for concurrent review services. Coordinates concurrent review activities to maintain compliance with all regulatory requirements and Medicare guidelines.

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

Essential Functions – Manager, Concurrent Review:

• Directs telephone access, utilization management process and coordinates day to day activities of the department

• Collaborates with Director of Concurrent Review to maintain staffing levels according to enrollment and designated departmental functions

• Assists in the review process for Concurrent Review policy and procedures to maintain compliance with all regulatory requirements

• Plan, conduct and monitor staff training which would include identification of opportunities for improvement.

• Coordinate and monitor reports for concurrent review activities

• Analyzes department activities using approved metrics and makes recommendations on matters with significant impact to the department

• Maintains a continuum of open communication with internal and external customers, especially payers

• Performs Inter-rater Reliability for Concurrent Review Staff

 

Maintains availability and willingness to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs.

 

Qualifications : Registered Nurse with an active PA license Must have at least three (3) years of demonstrated Concurrent Review experience in a Managed Care environment. Working knowledge of InterQual CriteriaFive (5) years of experience in a clinical setting.At least 2 years of supervisory/management experience Effective oral and written communication skills are necessaryExcellent interpersonal communication and problem solving skillsStrong organizational and time management skillsProficient computer skills

 

Positions Reporting:
 Concurrent Review Nurses

 Health Service Assistants

Intake staff