Clinical Review Manager
Location: Jackson Mississippi
Description: HMS is looking of Clinical Review Manager right now, this occupation will be placed in Mississippi. For complete informations about this occupation opportunity kindly read the description below. The Clinical Review Manager plans, organizes, and manages all aspects of assigned clinical review contract(s) from development to evaluation and facilitates team processes to ensure contract performance and achievement of deliverables. This position is the key point-of-contact with state Medicaid client and manages staff that perform clinical review duties.
Essential Functions:
Manages all clinical review services for contracts assigned.
Prepares outcome reports that show findings from project / contract activities. Effectively communicates project findings.
Manages assigned staff (both clinical and non-clinical)
Manages development and execution of all project / contract activities specifically defined by contract deliverables. Serves as a liaison to project team members and participants involved in the project.
Facilitates team processes to ensure successful project / contract implementation and performance. Serves as an internal and external educator. Manages project / contract using timeline developed by team and documents variations.
Serves as a resource to participants in project / contract activities in order to achieve effective quality improvement activities. Facilitates benchmarking, networking, and "best practice" sharing among project participants.
Performs needs assessment prior to undertaking projects / contracts to ensure that study is appropriate to customer needs and has greatest potential for impact. Negotiates and manages customer expectations of timelines, deliverables and final product to ensure that they are clear, realistic and obtainable.
Performs quality assurance checks on final clinical reviews and client deliverables.
Coordinates reviews with Medical Director and physician reviewers as appropriate.
Maintains professional competencies and knowledge for project, community relations, and customer service responsibilities as necessary for project. Prepares presentations and reports in concert with contract deliverables.
Monitors and fulfills contract requirements. Meets with client regularly.
Willing to travel 5-10%
Qualifications:
Bachelor's degree (BA/BS) from a four-year college or university in Nursing, Health Care Administration, or related field with minimum 3 years each of clinical and management experience and at least 2 years project management experience; or equivalent combination of education, experience and licensure. Current unrestricted health care licensure required.
Must have extensive knowledge and experience in utilization review of acute and ancillary services, behavioral health services, dental services, and radiology services.
Familiarity with state Medicaid rules and regulations highly desirable.
Demonstrated experience in and successful application of customer service and public relations skills.
Demonstrated leadership skills and successful experience working in an interdisciplinary team environment.
Excellent interpersonal skills with customer service orientation.
Excellent oral and written communication and presentation skills.
Knowledge in and successful application of coaching and delegation skills.
Knowledge in and successful application of team activities skills.
Knowledge in and successful application of basic level of health care data analysis skills.
Knowledge in and successful application of needs assessments skills.
Knowledge in and successful application of quality improvement skills in developing and implementing quality improvement programs.
Intermediate PC skills (Microsoft Office)
Demonstrated ability to effectively manage multiple priorities and multi-level tasks
Required Skills
Required Experience
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to HMS.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Wed, 18 Jul 2012 07:55:46 GMT