QUALIFICATIONS:

Education: Bachelor s of Nursing (BSN) preferred

License/Certifications:

Accredited/Certified Case Manager (ACM or CCM) designation strongly preferred
Registered Nurse (RN) required

Experience:

Two years of acute care, utilization management, or payer experience required
Ability to function autonomously maintaining a high level of clinical and
professional accountability
Demonstrates skill in creative problem solving, facilitation, collaboration,
coordination and critical thinking
Embraces change and continuously identifies opportunities for improvement by
demonstrating a commitment to creativity and innovation
Committed to promoting excellence in Customer Service; functions as a team
player
Computer literacy and data analysis skills are required
Maintains professional image by demonstrating strong verbal and written
communication skills
Demonstrates ability in self-starting, self-directing and clear
decision-making behaviors

Responsible to: Executive Director, Behavioral Health Services

Responsible for: No direct staff supervision responsibilities.

SUMMARY: Works in collaboration with the physician and interdisciplinary team
to support the underlying objective of enhancing the quality of clinical
outcomes and patient satisfaction while managing the cost of care and providing
timely and accurate information to payers. The role integrates and coordinates
utilization management and denial prevention by focusing on identifying and
removing unnecessary and redundant care and promoting clinical best practice.
Ensuring all patients receive the right care, the right cost, right time, and
in the right setting.

Salary Range: $30.90 – $55.62