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:

reputed 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):

Organization 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

This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds.