Program Manager - Risk Management Services - Registered Nurse

ESSENTIAL DUTIES & RESPONSIBILITIES:

 

1. Supervise Insurance Coordinator. Oversee the processing of applications, assigning class, identifying coverage issues, resolving billing problems, maintenance of database.

 

2. Credential new physicians enrolling in the  program.

 

3. Develop, implement, and monitor customer service and satisfaction levels.

 

4. Provide clinical expertise to the program relative to coverage issues, policy exclusions, and underwriting.

 

5. Engage in marketing and promoting of the program.

 

6. Act as primary liaison with Risk Managers at the hospitals.

 

7. Provide program information and guidance to the insureds and potential insureds.

 

8. Collaborate with Finance to resolve billing issues.

 

9. Perform other duties or special projects as required or assigned.

 

PERFORMANCE MEASURES:

 



1. Ensure all client inquires are responded to within one business day.

 

2. Complete application/credentialing processing within 5 business days.

 

QUALIFICATIONS:

 

Education/Certification:    -BA degree. Must have an RN degree.

   

Experience Required:  -5 years nursing experience in a hospital environment.

 

  -Experience in a risk management or insurance company a plus.

 

Skills/Abilities:     -Good PC skills.

 

      -Good interpersonal skills.

 

      -Knowledge of insurance terminology.

 

  -Knowledge of insurance policy, coverage, endorsements, and exclusions.