RN Manager, Quality Assurance & Utilization Review
A regional office in DC whose work helps improve and advance the efficiency, economy, effectiveness, and quality of healthcare services provided to enrolled District of Columbia Medicaid clients seeks an experienced RN Quality Assurance and Utilization Review Manager. Some of the services provided to clients include:
• Prior authorization review
• Pre-admission review
• Emergency admission review
• Continued stay review
• Retrospective review
• Long term care review
Reporting to our Project Director, the Manager would oversee clinical and non-clinical operations, ensuring fulfillment of all required contractual, legal, and accreditation standards plus compliance with corporate and Care Management policies. Typical responsibilities include:
• Contributes to, implements, and maintains departmental policies and procedures, staffing protocols, and training programs.
• Manages continuous quality improvement initiatives to improve the delivery, quality, and effectiveness of organization’s service delivery.
• Monitors the reliability and consistency of teams' work output to ensure adherence to contract deliverables; collaborates with the Project Director to effectively and timely address issues that are identified.
• Attends monthly performance meetings with the District’s contracting officer’s representative; provides feedback on the findings of the monitoring activities, identifies opportunities for performance improvement, and steps that must be taken to implement initiatives or complete corrective action.
• As needed, may also conduct utilization management reviews, plus other case reviews.
• BA / BS in a related field.
• MA / MS in a related field preferred.
• Current, active, unrestricted RN licensure in D.C.
• Must be able to work onsite in D.C. (Metro Center).
• 3+ years of Medicaid-specific UR and QA experience (with MA or MS), or
• 5+ years of Medicaid-specific UR and QA experience (with BA or BS).
• Proficiency with utilization review, community-based programs, quality assurance / improvement, and Medicaid.
• Supervisory and/or management experience.
NRI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with disability.