REQUIRED EXPERIENCE AND SKILLS:
• Minimum of three years recent acute clinical experience required
• Minimum of three years utilization review/manage care experience
• Prior supervisory experience with the ability to manage a large team of diverse employees with differing job descriptions
• Managed care experience in medical management desirable, preferably in an HMO or IPA setting
• Experience with ICD-9, CPT and HCPCS codes preferred
• Must possess the ability to read health plan guidelines, understand the statistics of this department, contracts, claims and customer service principles
• Advanced practice certification, ARNP or Masters prepared, with certifications applicable to position (CCM, CDMS, CRC, CRRN, CHON, and CPUR)
• Working knowledge of utilization management, reimbursement, medical necessity criteria including InterQual
• Knowledge of managed care concepts, Medicare/Medi-Cal Guidelines.
• Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access systems. Ability to navigate through various software programs with instruction.
• Requires current California RN license with 5+ years in Utilization Management
If you have the experience & qualifications. please respond with your resume in a Word document.
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Job details are sourced from the employer's original posting.
Open job postingAbout the company
Healthcare Talent is assisting our client in their search for a Compliance Specialist, Delegation Oversight, for a vital position in their rapidly growing healthcare organization. In accordance with organizational policies, the candidate will maintain federal regulatory compliance for all pertinent matters and will performs compliance program activities including coordination of delegation oversight activities to ensure compliance with requirements.