Supervisor-Care Management *BSN & RN Required; 3 years of relevant experience required*
$133,380–$168,000 year
On-siteMineola, New York, United States
Job Summary
Supervise utilization management, discharge planning, and progression of care to promote quality and safe transitions. Coordinate departmental operations, including educational updates, policy development, and quality performance improvement programs. Oversee admission screening, concurrent denials, and the issuance of non-coverage letters while facilitating interdisciplinary case conferences and post-acute care placements. Guide staff on care management and partner with Physician Advisors to promote operational efficiency. Requires BSN, RN license, and 3+ years of experience in acute care, utilization management, and insurance denial appeals. Salary range $133,380 - $168,000 annually.
Required Qualifications
- Bachelor's Degree Nursing
- Current and valid New York State Registered Professional Nurse license
- BLS certification (Issued by the American Heart Association-AHA)
- NYS DOH certification as a Patient Review Instrument (PRI) Assessor
- 3 - 5 years in depth experience inclusive of acute care clinical patient care, utilization management, discharge planning, post acute care placement, and insurance denial management
- Excellent communication (both oral and written)
- Interpersonal skills
- Strong organizational skills
- Leadership skills
- Prioritization skills
- Problem solving skills
- Deductive reasoning skills
- Knowledge of insurance denial and appeals process inclusive of external appeal, dispute resolution authority issues, commercial and government reimbursement mechanisms and managed care issues
- Enhanced understanding of utilization management, progression of care, and case management operations within the acute care Hospital setting
- Expanded clinical knowledge of standards of practice applicable to levels of patient care
- Basic computer skills including MS Office
- BSN & RN Required
- 3 years of relevant experience required
Desired Qualifications
- Master's Degree Nursing
- NYS Department of Health (DOH) certification as a Screen Assessor
- 1-2 years Management or supervisory
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