Description:
Coventry Health Care is seeking a Supervisor, Concurrent Review Nurse for Long Term Care Department for our Sunrise, FL location. The successful candidate will responsible for the daily supervision of the Concurrent Review. Serves in an active managerial role to assisting the development, implementation, and evaluation of the utilization management process.
ESSENTIAL RESPONSIBILITIES:
- Provides oversight and direction to the specific members in the area of concurrent review 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 adversely 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 and is responsible for assuring that these issues are reported to the Quality Improvement department.
- Performs other duties as required.
Qualifications:
Basic Qualifications:
- Registered nurse with current state RN license.
- 2 or more years experience in utilization management.
- 3 or more years clinical experience.
- 2 or more years supervisory experience.
Preferred Qualifications:
- Bachelor's degree with current state RN license.
Other:
- Highly self-motivated and able to work well under stress in a fast-paced environment.
- Effective verbal and written communication skills.
- Excellent organizational aptitude and high attention to details.
Coventry Health Care, a $12.2 billion Fortune 500 organization, is a national managed health care company with nearly 5.1 million members in all 50 states. At Coventry Health Care, we are driven to ensure that every person and organization we serve receives the greatest possible value for their health care investment. We do this by providing a full range of competitive products through our seven core businesses - Commercial Risk, Medicare Advantage, Medicare Part D, Medicaid, Workers' Comp Services, Federal Employees Health Benefits Plan and Network Rental.
We are committed to constantly improving our low-cost platform so that we can deliver the products and services that our customers want at a price they can afford. Coventry has the expertise, the experience, and the agility to craft the new products, the new processes, and the new service needed to make healthcare more accessible to all Americans.
We offer a competitive salary, excellent benefits (401K with company matching, comprehensive benefits including medical, dental, and tuition reimbursement), vacation and sick time. This is a highly visible role dealing with business partners across the division and corporation, and being a part of motivating a dynamic team!
Please apply directly to http://jobs.coventryhealthcare.com and refer to Req#1311116, Supervisor, Concurrent Review Nurse for Long Term Care Department.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Sunrise, FL, US
Other Locations: ,
Organization: 32000 - Florida Health Plan Admin. LLC
Schedule: Full-time
Job Posting: 2013-11-12 00:00:00.0
Job ID: 1311116
Coventry Health Care is seeking a Supervisor, Concurrent Review Nurse for Long Term Care Department for our Sunrise, FL location. The successful candidate will responsible for the daily supervision of the Concurrent Review. Serves in an active managerial role to assisting the development, implementation, and evaluation of the utilization management process.
ESSENTIAL RESPONSIBILITIES:
- Provides oversight and direction to the specific members in the area of concurrent review 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 adversely 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 and is responsible for assuring that these issues are reported to the Quality Improvement department.
- Performs other duties as required.
Qualifications:
Basic Qualifications:
- Registered nurse with current state RN license.
- 2 or more years experience in utilization management.
- 3 or more years clinical experience.
- 2 or more years supervisory experience.
Preferred Qualifications:
- Bachelor's degree with current state RN license.
Other:
- Highly self-motivated and able to work well under stress in a fast-paced environment.
- Effective verbal and written communication skills.
- Excellent organizational aptitude and high attention to details.
Coventry Health Care, a $12.2 billion Fortune 500 organization, is a national managed health care company with nearly 5.1 million members in all 50 states. At Coventry Health Care, we are driven to ensure that every person and organization we serve receives the greatest possible value for their health care investment. We do this by providing a full range of competitive products through our seven core businesses - Commercial Risk, Medicare Advantage, Medicare Part D, Medicaid, Workers' Comp Services, Federal Employees Health Benefits Plan and Network Rental.
We are committed to constantly improving our low-cost platform so that we can deliver the products and services that our customers want at a price they can afford. Coventry has the expertise, the experience, and the agility to craft the new products, the new processes, and the new service needed to make healthcare more accessible to all Americans.
We offer a competitive salary, excellent benefits (401K with company matching, comprehensive benefits including medical, dental, and tuition reimbursement), vacation and sick time. This is a highly visible role dealing with business partners across the division and corporation, and being a part of motivating a dynamic team!
Please apply directly to http://jobs.coventryhealthcare.com and refer to Req#1311116, Supervisor, Concurrent Review Nurse for Long Term Care Department.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Sunrise, FL, US
Other Locations: ,
Organization: 32000 - Florida Health Plan Admin. LLC
Schedule: Full-time
Job Posting: 2013-11-12 00:00:00.0
Job ID: 1311116