Mgr, Health Services - HPN Job job at Coventry Health Care in Kansas City

Coventry Health Care is looking of Mgr, Health Services - HPN Job on Sat, 30 Mar 2013 12:20:31 GMT. Description: GENERAL SUMMARY Responsible for the daily management in one or more of the various health services areas (Pre-authorization, Concurrent Review, Complex Case Management, Appeals, and/or Disease Case Management). Serves in an active managerial role to assist in the development, implementation, and evaluation of the utilization management process. Will work with regional HPN's and meet...

Mgr, Health Services - HPN Job

Location: Kansas City Missouri

Description: Coventry Health Care is looking of Mgr, Health Services - HPN Job right now, this job will be placed in Missouri. Detailed specification about this job opportunity please read the description below. Description:
GENERAL SUMMARY

Responsible for the daily management in one or more of the various health services areas (Pre-authorization, Concurrent Review, Complex Cas! e Management, Appeals, and/or Disease Case Management). Serves in an active managerial role to assist in the development, implementation, and evaluation of the utilization management process. Will work with regional HPN's and meet face to face with providers.

ESSENTIAL RESPONSIBILITIES

• Provides management and direction to one or more health services areas (Pre-authorization, Concurrent Review, Complex Case Management, Appeals, and/or Disease Case Management); including, staffing, training, monitoring, and evaluating.
• Reviews the timeliness, appropriateness, and medical necessity of the utilization processes performed by the staff. Prepare reports detailing the monitored activities.
• Actively participates in the development, implementation, and oversight of the department’s activities; serves in an adjunct role for policy and procedure development and implementation.
• Assists in the identification of issues which may adve! rsely impact the attainment of department goals/initiatives (i! .e., inpatient bed days per thousand, outpatient surgery utilization, etc.).
• Collaborates with other departments to educate providers, vendors, and members regarding network providers/specialists benefits and utilization management policies and procedures.
• Attends meetings 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 employment, termination, performance reviews, salary reviews, and disciplinary actions.!
• Performs other duties as required.

Qualifications:
JOB SPECIFICATIONS

• Registered nurse with active state RN license.
• Bachelor’s degree or equivalent experience.
• Previous (5-7 years) experience in utilization management.
• Previous (3-5 years) clinical experience.
• Previous (3-5 years) managerial experience.
• Experience in program development preferred.

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: First/Mid Level Officials and Managers
Primary Location: Kansas City, MO, US
Other Locations: St. Louis-Missouri-United States,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-03-29 00:00:00.0
Job ID: 1311158
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If you were eligible to this job, please email us your! resume, with salary requirements and a resume to Coventry Health Care.!

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Sat, 30 Mar 2013 12:20:31 GMT

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