Nurse Supervisor, Utilization Management

Location: Harrisburg, PA
Nurse Supervisor, Utilization Management
 
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies.
 
Our client serves more than 55 million managed care members through their portfolio of high-quality commercial and government sponsored healthcare programs. The broad offering of programs that they provide has helped them to build both capacity and capability to successfully navigate a changing healthcare environment, while continuing to offer better health outcomes at lower costs.
 
Position Purpose:
Supervise the daily operations of the utilization management (UM) department
 
Job Description:
  • Supervise the daily operations of the UM staff
  • Ensure appropriate usage of resources in order to facilitate the UM process
  • Ensure compliance within applicable state program guidelines
  • Evaluate compliance policies and procedures and analyze/recommend enhancements
  • Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements
  • Identify opportunities for process improvements necessary to facilitate department functions
  • Educate staff as necessary to ensure consistent performance and adhere to standards
  • Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary
 
Qualifications:
Education/Experience:
  • 3+ years of utilization management/quality improvement experience.
  • Working knowledge and understanding of basic utilization management and quality improvement concepts.
  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
 
Licenses/Certifications:
  • Pennsylvania RN, LPN, or LVN
 
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
 
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.
 
 
 
 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 
https://www.indeedjobs.com/proenlist?hl=en_US
 
 
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