Utilization Review Manager- RN

Utilization Review Manager- RN

LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare's client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.

We seek a full time Utilization Review Nurse Manager to join our new operations center in Long Island City, New York.

The Utilization Review Nurse Manager will be responsible for reviewing non-emergency medical transportation requests for stretcher, ambulance and wheelchair transport; will obtain appropriate medical information to make administrative determinations and will work closely with LogistiCare staff to assist in quality assurance of these trips. The UR Manager will develop policies and procedures for the medical UR function and will manage and direct a small team of employees.

Essential Functions and Responsibilities:

- Review all ambulance and stretcher trips to assure appropriate utilization of resources

- Screen all medical documentation and make decisions based on provided information to determine the most efficient and appropriate method of transport or most appropriate medical provider

- Work closely with Utilization Review Specialist to ensure all approved trips are entered correctly into LogistiCad system

- Maintain client confidentiality by compliance with HIPPA guidelines and LogistiCare confidentiality policy

- Act as a resource for LogistiCare staff for medical questions

- Actively work with the Operations Management team on overall QA Plan for operation

Other Duties and Responsibilities:

- Make suggestions for and updates policies and procedures as needed

- Maintains all confidential client information in files

- Participates in in-services as needed or requested by manager

LogistiCare is an equal opportunity employer.

Credentials:

- RN with active New York license strongly preferred

Experience:

- Strong Utilization Review professional background preferred or at least 4
years recent clinical experience.

- Prior Managed Long Term Care experience required

- Ability to effectively manage multiple business units and functions as well as staff

- 1+ years call center experience preferred

- Supervisory experience and ability to manage and lead a small team of 5+ employees

- Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services strongly preferred

- Broad knowledge of health care system including hospital, nursing home and community medical knowledge

- Computer proficiency with Microsoft Office Suite, and Access

Competencies:

- Must possess excellent written and verbal communication skills to facilitate effective communications and correspondence with internal and external management and clients

- Interpersonal: Ability to get along well with a variety of personalities and individuals

- Team Player: Ability to comfortably work as part of a team to ensure that the organization runs smoothly in a spirit of cooperation and can be relied on to complete tasks and work cooperatively with others

- Decision Make: Ability to make critical decisions while following company procedures