RN Director of Utilization Review

Sacramento, California

Position Summary:  

The RN Director of Utilization Review oversee operations for referral management, telephonic utilization review, prior authorization functions, and case management programs (Medical Management)

In office position, but may have to go out in the field for meetings and etc.

Overseeing a staff of approx. 35

Hours for this Position:  Monday –Friday/ 8:30am-5:00pm

Advantages of this Opportunity:

• 20% Annual Bonus
• Excellent benefits –Effective after 30 days of hire
• PTO-3 weeks’ vacation-1st year

Required Skills

What We Look For:

• RN Required
• UM and/or CM Experience is a MUST! (Concurrent Review, Prior Authorization) At least one year
• 5+ years of Clinical Nursing experience in an Acute Care setting particularly in Medical/Surgical, Pediatrics or OB
• ‘Director’ experience preferred, but will consider candidates w/ ‘Manager’ titles
• Quality Experience Preferred
• BEST candidate would be someone from another Managed Care company
• 2nd BEST would be someone who worked on the Provider Side-i.e. Assisted Living Facility, Hospital, etc.

Responsibilities

More Insight of Daily Responsibilities: 

Position Purpose: The RN Director of Utilization Review oversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy and objectives of Corporate and the health plan.

• Oversee the operations of the referral management, telephonic utilization review, prior authorization, and case management functions.

• Support and perform case management, disease management

• Provide support to Provider Relations issues related to Utilization issues for hospitals and physician providers.

• Coordinate efforts with the Member Services and Connections Departments to address members and providers issues and concerns in compliance with medical management requirements.

• Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for the prior authorization unit.

• Develop, implement and maintain policies and procedures regarding the prior authorization function.

• Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes.

• Compile and review multiple reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting.

Want More Information?

Interested in hearing more about this great opportunity? Reach out to Ivory Williams at iwilliams@healthcaresupport.com for immediate consideration.
Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Salary

$115,000-$130,000