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UR Department Manager
Orange, CA
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| Career Field |
Medical/Case Management
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| Insurance Discipline |
Managed Care
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| Relocation Assistance |
Not Available
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| Job Duration |
Full Time |
| Salary Offered |
$80,000 - $80,000/ year
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Utilization Review Department Manager - Orange CA
ESSENTIAL DUTIES AND RESPONSIBILITIES
Direct oversight over 2 UR Supervisors
Oversee UR processes for department
Interface with, but not limited to clients, providers, medical staff, vendors, and patient care facilities
Work in collaboration with the Medical Director on medical aspects of the UR and Case Management Department
Interface with internal departments, including but not limited to, Medical Bill Review and Accounting
· Identify and appropriately report issues
· Responsibility in UR issue resolution
· Ability to coordinate Department processes with corporate strategies while meeting client business requirements
· Manage the implementation of new UR clients and coordinate with MBR and other vendors, and internal Accounting Department, as appropriate
· Coordinate QA/QC tasks with Auditor/auditing processes
· Responsible for successful completion of accreditation activities
· UR issue and complaint management
· Ensure compliance with governance certifications such as URAC and others
· Resource to UR department and clients of state and other governing entity regulatory requirements
· Other duties as assigned
Licensed - RN + 5 years Utilization Review experience with at least 2 showing progressive management experience preferred.
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Please Reference NIRA# 5658/GIR41632
QuestPro Consultants
Kevin Burch
17300 Preston Rd. Suite 350
Dallas, TX 75252
(972)960-1305
(972)960-1357 -- fax
kburch@questpro.com
http://www.questpro.com
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