Remote Utilization Management Team Leader / LPN / RN / PA

Job ID: 257724    Posted 6/12/2024

LOCATION

Location: New York, New York

JOB TYPE

Job Type: Direct Hire

CATEGORY

Category: Case Management

POSITION

Position: 257724

SKILLS

Skills: Interqual

SALARY

Salary Low: $110000 - Salary High: $115000

DURATION

Duration: 2 Weeks

SHIFT

Shift:

Job Description

Utilization Management Team Leader, LPN / RN / PA – Remote / Downtown, Manhattan /  Work from Home Role
Monday Through Friday, Business Hours, Full-time, Permanent Role
Generous Benefits (Pension Plan) and Salary up to $115,000
Must be a Licensed Nurse or Physician Assistant in the State of New York! 
Position Overview:
The UM Team Leader, under the direction of the Senior Director of Clinical Services provides oversight of the administration of departmental utilization management activities.
Scope of Role & Responsibilities:

  • Supervise staff conduct utilization review.
  • Oversee utilization review activities and ensure cases are reviewed timely meeting NYS DOH and CMS regulatory standards.
  • Support care management team development through direct staff training and development activities.
  • Conduct utilization review and quality of care monitoring activities in conjunction with care management program staff.
  • Quarterly audits of clinical staff.
  • Investigation and resolution of clinical claims related issues
  • Support departmental training and clinical quality improvement activities.
  • Participate in the development, implementation, and evaluation of performance improvement initiatives.
  • Ensure that standards of care delivery are consistent with current professional standards and consistent with the Mission, Vision, and Values of the organization.
  • Actively participate in Article 44/49 and CMS audit activities.
  • Participate in committees, as assigned.
  • Other responsibilities as directed by the Senior Director of Clinical Services or Chief Medical Officer.

Required Education, Training & Professional Experience:

  • At least 2 years of managed care experience
  • Knowledge of InterQual required.
  • Prior supervisory experience preferred.
  • Computer literacy and excellent written and oral communication skills required.

Licensure and/or Certification Required:

  • Registered Nurse with a current New York State License, Licensed Practical Nurse, or Physician Assistant with significant managed care experience.

Generous Benefits (Pension Plan) and Salary up to $115,000
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At RCM Health Care Services, we redefine healthcare staffing, creating an environment where your career thrives and flourishes. Our commitment to your success is woven into the fabric of our culture, offering diverse opportunities for both seasoned professionals seeking challenges and newcomers ready to make their mark. As a part of the RCM family, you'll experience more than just a job – you'll find a platform for continuous growth and fulfillment.

We have cultivated an ecosystem where healthcare professionals not only find rewarding career opportunities but also a community that values their skills and dedication. Your success is our priority, and our collaborative environment ensures you're never alone on your professional journey. Competitive salaries and comprehensive benefits reflect our dedication to your well-being, allowing you to focus on what matters most – delivering exceptional care. Join RCM Health Care Services, a trusted partner with a proven track record since 1975 and embark on a journey where your path to a fulfilling healthcare career truly begins.

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With a legacy spanning over 45 years, RCM Health Care Services is a leader in connecting healthcare professionals with rewarding career opportunities. Our foundation is built on cultivating relationships with school districts, setting the stage for our expansion into placing providers across diverse facility types. As we evolved, our expertise diversified across various divisions including School Services, Behavioral Health/ABA, Travel, Nursing, Therapy, HIM, Permanent Placement, Foreign Recruitment, Locums Tenens, and much more.
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