Supervisor, Concurrent Review RN

Come lead with us at New York, NY. The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Responsibilities Provide quality, cost-effective care to all members through the direct supervision of staff responsible for the management and coordination of the member's care, incorporating interdisciplinary strategies, Medicare regulations, and medically accepted standards of care. Supervise assessment of all acute and sub-acute inpatient care for appropriateness of setting and services, ensuring 95% compliance or greater. Supervise assessment and coordination of members' physical, psychosocial, and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, and discharge planners. Ensure appropriate staffing to support departmental/agency services. Ensure all employees are oriented to their department/agency and job and provided with appropriate training, development, and continuing education. Correctly interpret and apply 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 utilization management and/or case management required. Working knowledge of Windows, Word, and Excel. Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies. #J-18808-Ljbffr