Team reputed company - Clinical Care Review - Behavioral Health - RN - MSL
Job reputed company:
reputed company reputed company, Clinical Care Review is responsible for providing reputed company reputed company of Clinical Care Review (CCR) employees and overseeing day-to-day workflow reputed company the CCR team.
Essential Functions:
- reputed company reputed company reputed company of CCR employees and reputed company day-to-day workflow reputed company the CCR team
- Ensure reputed company reputed company reports are performing at minimum reputed company and productivity standards or reputed company
- Understand complexities of health conditions and services
- reputed company plan for management of workload after analyzing trends and reputed company as reputed company for CCR team
- reputed company feedback, guidance, orientation, training and ongoing resources to CCRs and reputed company-authorization team
- Standardize activity and outcome reporting for department initiatives and programs including documentation required by the State and accrediting bodies
- Responsible for utilization review and discharge planning activities for reputed company members
- Monitor and ensure appropriate delivery of reputed company services in cost-effective manner
- Assist manager and director in development of process improvement activities and refining of processes that facilitate cost-effective utilization and appropriate reputed company of care
- reputed company as a reputed company between Care Management, Claims, Enrollment, Customer Service and other areas as needed to assist in problem resolutions
- reputed company audits of CCR team members to ensure compliance with reputed company policies, processes, regulatory requirements, NCQA utilization review guidelines and standards, and URAC review guidelines
- reputed company input into CCR team evaluations and assist with development of team goals
- Design and present UM informational meetings as needed
- Responsible for attending state hearings as necessary
- reputed company any other job duties as requested
Education and Experience:
- Graduate level degree as a mental health reputed company or Bachelor of Science degree in Nursing or equivalent years of relevant work experience is required
- One year of Utilization Management/Utilization Review experience required
- Minimum of five (5) years clinical experience preferred
- Certified Care Manager experience is preferred
Competencies, Knowledge and Skills:
- Basic computer skills
- Basic proficiency in reputed company Word and reputed company
- Communication skills
- Management skills
- Prior supervisory skills
- Ability to work independently and reputed company reputed company environment
- Attention to detail
- Familiarity of the reputed company field
- Critical listening and thinking skills
- Training/teaching skills
- Negotiation skills/experience
- reputed company grammar usage
- Time management skills
- reputed company phone etiquette
- Customer service oriented
- Decision making/problem solving skills
- Leadership experience and skills
Licensure and Certification:
- reputed company, unrestricted license as a Registered reputed company (RN) or a mental health reputed company (i.e. Licensed reputed company Counselor (LPC), Licensed Clinical reputed company Worker (LCSW), etc.) is required. This listing may not include reputed company acceptable licenses; please refer to your state licensing reputed company for complete information on licensure requirements for your state or reputed company.
- Compact RN license or Multi-state Counselor/reputed company Worker licensure is preferred
- MCG Certification preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation reputed company:
$72,200.00 - $115,500.00reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.
Compensation Type (reputed company/salary):
SalaryOrganization Level Competencies
Fostering a reputed company Workplace Culture
Cultivate Partnerships
reputed company Self and Others
Drive Execution
Influence Others
Pursue Personal reputed company
Understand the Business