Manager - Registered Nurse
GLC Associates - Tampa, FL

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Medical Management - Registered Nurse

Responsible for the management of pre-authorizations, concurrent reviews, complex case management appeals, or disease case management. Serves in an active managerial role to assist in the development, implementation, and evaluation of utilization management.

- Provides management and oversight to one or more health service areas???including staffing, training, monitoring, and evaluating
- Reviews the timeliness, appropriateness, and medical necessity of the utilization processes performed by the staff. Prepares reports detailing the monitored activities
- Actively participates in the development, implementation, and oversight of department activities. Serves in an adjunct role for policy and procedure development and implementation
- Assists in the identification of issues which may adversely impact the attainment of department goals/initiatives
- Collaborates with other departments to educate providers, vendors, and members regarding network providers/specialists benefits and utilization management policies and procedures
- Attends meeting with internal workgroups and external business parties
- Assists in the identification and triage of potential quality improvement issues. Responsible for assuring issues are reported to the Quality Improvement Department
- Responsible for compliance with State and Federal law regarding the handling of utilization management decisions and/or appeals. Ensures compliance with national accrediting body standards regarding utilization management decisions and/or grievances
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including but not limited to employment, termination, performance reviews, salary reviews, and disciplinary actions
- Performs other duties as assigned

- RN with active license in good standing in the state of FL
- Bachelor's degree or equivalent experience
- Previous experience (5-7 years) in utilization management
- Previous experience (3-5 years) clinical experience
- Previous experience (3-5 years) management experience
- Experience in program development preferred