What are the responsibilities and job description for the Utilization Management Clinical Manager (RN) position at Integra Partners?
The Utilization Management Clinical Manager RN is responsible for the overall management of the Utilization Management department. This includes overseeing the day-to-day operations of the department, as well as developing and implementing new programs and initiatives. The Manager is also responsible for ensuring that the department meets all regulatory requirements, and that the quality of care is maintained. The manager will be responsible for providing leadership and guidance to the team to ensure compliance with regulatory requirements and health plan policies. The position will report to the Director of Utilization Management and work closely with other departments to ensure timely and accurate utilization management decisions.
Salary: $115,000.00/annual
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The Utilization Management Clinical Manager RN’s responsibilities include but are not limited to:
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EDUCATION:
- Active, unrestricted Registered Nurse
- Bachelor's degree in nursing (BSN)
EXPERIENCE:
- Bachelor's degree in nursing (BSN)
- Registered Nurse (RN) licensure
- Minimum of 3 years of nursing in an acute or outpatient setting
- Minimum of 5 years of UM experience in a managed care, payor environment
- Experience with New York Medicare and Medicaid.
- Knowledge of regulatory requirements related to utilization management, such as CMS and NCQA standards
- Strong communication, leadership and analytical skills
- Ability to work effectively in a fast paced, team-oriented environment
- Proficiency in Microsoft Office application and health plan systems
- Experience with Medicare, Medicaid UM authorizations and appeals for DMEPOS
- Experience with Medical Necessity Criteria including but not limited to InterQual, CMS guidelines, health plan medical policies, etc.
- Verbal and written communication skills to convey information clearly and consistently
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the quality of life for the communities we serve.
With locations in New York City and Michigan, plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
Salary : $115,000 - $115,001
