Supervisor, Concurrent Review

Responsibilities

Provides quality, cost-effective care to all members through the direct supervision of staff responsible for the management and coordination of the member's care through the incorporation of interdisciplinary strategies, medicare regulations, and medically accepted standards of care.

Supervises the assessment of all acute and sub-acute inpatient care for appropriateness of setting and services, according to pre-established criteria and guidelines and ensure a 95% compliance or greater.

Supervises the assessment and coordination of the members physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, discharge planners.

Affirms appropriate staffing to support departmental/agency services.

Ensures all employees are oriented to their department/agency and job and provided with appropriate training, development and continuing education.

Correctly interprets and applies all Human Resources policies and procedures relative to discipline, recruitment and selection, performance appraisals, salary reviews and staffing.

Qualifications

Bachelor's Degree in Nursing.

Minimum one to three years previous management experience preferred.

Previous managed care experience in the areas of utilization management and/or case management required.

Working knowledge of Windows, Word, Excel.

Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies.

Pay

$101,503.41 - $126,879.27 per year