Manager, Secondary Review - Albuquerque, NM - Outstanding Leadership Role!
Location: Albuquerque New Mexico
Description: UnitedHealth Group is currently seeking to employ Manager, Secondary Review - Albuquerque, NM - Outstanding Leadership Role! right now, this occupation will be placed in New Mexico. For detail informations about this occupation opportunity kindly see the descriptions. There's energy and excitement here, a shared mission to improve the live! s of others as well as our own. Are you ready for a new path? Start doing your life's best work.
As a Manager of Secondary Review working with our NM Centennial Care members, you will be supervising and managing a team of Utilization Management Secondary Reviewers responsible for the determination of a HCBS and level of care for such services. This is an office-based position in our Albuquerque office, working the hours of 8am – 5pm Monday through Friday.
Primary Responsibilities:
Manages and supports all UM Secondary Review activities related to the review and determination of HCBS based upon the comprehensive needs assessment and/or related clinical criteria
Reviews quality of documentation as part of the review process
Assists in the development and delivery of UM Secondary Review curriculum and training as part of initial hiring and ongoing refresher training for both secondary reviewers and care coordination staff
Compile! s and analyzes reports, reviews trends, and creates associated! action plans to address performance on targeted metrics
Assures consistency in clinical decision making through the IRR and audit process
Acts as the UM Secondary Review subject matter expert and represents the team as it relates to secondary review processes and protocols
Meets weekly with UM Secondary Review staff to provide guidance, support, and coaching as needed
Research and problem-solve inquiries received from Managers, Care Coordinators, members and their representatives, or other internal / external stakeholders
Reviews and updates authorizations and other data in the electronic case management system
Forecasts and plans staffing resource requirements
Routinely attends and audits internal practices related to the appeals and fair hearings processes
May provide testimony in appeals and fair hearings proceedings on behalf of a team member or for the purpose of offering support
Works closely with compliance and clinical leadership! to discuss protocols and engagement of legal counsel as appropriate
Requirements:
A current and unrestricted RN license for the state of New Mexico, a licensed Medical Social Worker, or a licensed physical / occupational / rehab therapist
Minimum of 2 years of clinical work experience with the Long Term Care population
Minimum of 1 year of management experience with a team size minimum of 5
Ability to build and maintain relationships and work independently will be essential
Technical working knowledge of Word, Excel, PowerPoint, Outlook and Internet Explorer, with the ability to navigate a Windows environment
Assets Preferred:
Familiarity with New Mexico’s Nursing Facility Level of Care and/or Home and Community Based Services
A background that involves utilization review for LTC Home and Community Based Services or Third Party Assessor functions in a managed care environment
UnitedHealthcare Community ! & State is part of the family of companies that make UnitedHealth Group! one of the leaders across most major segments of the US health care system. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all it takes an entire team of talentâ€â€individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Diversity cr! eates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
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This occupation starts available on: Sat, 20 Jul 2013 23:22:12 GMT
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