利用管理主管
Supervisor, Utilization Management
职位职责：监督优先授权、同时评审和/或回顾性评审临床评审团队，以确保会员获得适当的护理。监督利用管理团队的日常活动。
关键信息：远程岗位。候选人必须持有有效、活跃且无限制的内华达州注册护士（RN）执照。也考虑持有综合RN执照并愿意申请内华达州RN执照的合格候选人。远程岗位，周一至周五上午8点至下午5点太平洋时间。
- 监控和跟踪UM资源，以确保符合绩效、合规性、质量和效率标准
- 与利用管理团队合作解决复杂的会员护理问题
- 保持对与利用管理相关的法规、认证标准和行业最佳实践的了解
- 与利用管理团队和高级管理层合作，识别利用管理中的流程和质量改进机会
- 为利用管理团队提供关键计划的教育和资源，并促进利用管理团队、会员和供应商之间的持续沟通
- 监控优先授权、同时评审和/或回顾性临床评审护士，并确保遵守适用的指南、政策和程序
- 与高级管理层合作制定和实施确保医疗保健服务适当有效利用的UM政策、程序和指南
- 评估利用管理团队的绩效，并就绩效、目标和职业里程碑提供反馈
- 为利用管理团队提供指导和建议，以确保遵守质量和绩效标准
- 协助利用管理团队成员的入职、招聘和培训
- 在职责范围内领导和推动变革
- 完成其他指派的任务
- 遵守所有政策和标准
教育/经验：需要毕业于认可的护理学校或获得学士学位，并有4年以上相关经验。
熟悉利用管理原则者优先。
执照/认证：
· RN - 注册护士 - 需要州执照和/或综合州执照
薪资范围：每年75,300.00至135,400.00美元
在Centene，我们帮助人们获得他们需要的护理，以过上更健康的生活——你在这里的工作每天都会产生实际的影响。你将承担有意义的挑战
查看英文原文
Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
Key Details: Remote role. Candidates must possess a valid, active, and unrestricted Nevada Registered Nurse (RN) license. Willing to consider qualified candidate with Compact RN license willing to apply for Nevada RN License . Remote Role, Monday - Friday 8AM to 5PM PST.
- Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
- Collaborates with utilization management team to resolve complex care member issues
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
- Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
- Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
- Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
- Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
- Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
- Assists with onboarding, hiring, and training utilization management team members
- Leads and champions change within scope of responsibility
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification:
· RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Pay Range: $75,300.00 - $135,400.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas