Clinical Nurse Manager
Our client needs an innovative and forward thinking Clinical Nurse Manager/Utilization Manager who will be accountable for the day-to-day operations of the Medical Review and Care Management teams.  This position ensures medical services are provided within established timelines in order to support Providers and members in meeting the healthcare needs of our Members. This supports our overall effort to achieve annual departmental and company business goals and our client's mission to Create Healthy Individuals Through Innovative Systems. In this critical role, you will report to the Director of Integrated Clinical Services and oversee a team of 15 nurses in the Integrated Health Services Division What you will do…Ensure appropriate utilization management, which focuses on helping members obtain the right care to achieve better overall healthEvaluate members’ care according to established criteria, guidelines and under the provisions of an applicable health benefits planUse proactive procedures and processes such as pre-certification, concurrent planning and reviews, peer reviews, discharge planning and clinical case redeterminationsConduct performance management activities by monitoring performance; conducting one on one meetings to share, receive and discuss information and by providing regular feedback to enhance performanceActively participate in leadership teams within the organization to ensure consistent leadership, collaboration and communication across the organizationMonitor key indicators of department performance and take steps to ensure established targets are met
Title: Clinical Nurse Manager
Salary: 110-140
Description: Our client needs an innovative and forward thinking Clinical Nurse Manager/Utilization Manager who will be accountable for the day-to-day operations of the Medical Review and Care Management teams.  This position ensures medical services are provided within established timelines in order to support Providers and members in meeting the healthcare needs of our Members. This supports our overall effort to achieve annual departmental and company business goals and our client's mission to Create Healthy Individuals Through Innovative Systems. In this critical role, you will report to the Director of Integrated Clinical Services and oversee a team of 15 nurses in the Integrated Health Services Division What you will do…Ensure appropriate utilization management, which focuses on helping members obtain the right care to achieve better overall healthEvaluate members’ care according to established criteria, guidelines and under the provisions of an applicable health benefits planUse proactive procedures and processes such as pre-certification, concurrent planning and reviews, peer reviews, discharge planning and clinical case redeterminationsConduct performance management activities by monitoring performance; conducting one on one meetings to share, receive and discuss information and by providing regular feedback to enhance performanceActively participate in leadership teams within the organization to ensure consistent leadership, collaboration and communication across the organizationMonitor key indicators of department performance and take steps to ensure established targets are met
Requirements: None experience, Bachelor's Degree education
Fraudulent: No