Manager Clinical Review - Hybrid
US-NJ-Camden
External Career Portal
Req #: 72478
Type: Full Time
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Responsibilities: Under the direction of the AVP of Care Management and Healthcare Access, the Manager of Clinical Review maintains daily operations of the hospital Clinical Review Department. Excellent communication and interpersonal skills. Team building skills with the ability to function independently and interdependently as a member of the Care Management Leadership Team. Demonstrates the ability to be flexible in work schedules and coverage; this includes the ability to manage some staff remotely. Strong organizational, innovation, and problem-solving skills. Strong decision-making skills. Ability to establish strong team building with the both internal and external customers. Manages daily UM operations for the department including staffing, schedules, recruitment, onboarding, and performance management. Monitors departmental performance indicators, goals and objectives that are consistent with organizational strategic goals, mission, and vision. Monitors reports and workqueues and implements change accordingly. Maintain the quality of the review process among all personnel including development and implementation of staff audits that give meaningful and measureable data and an understanding of strengths and areas for improvement. Responsible for the development and implementation of process improvements. Reviews observation/SDS cases daily and initiates communication and referral activity to ensure correct status designation. Collaborates with Physician advisors and AVP to assure UM workflows are being addressed according to the UM plan, and active participant in the UM committee. The above are guidelines for the position but are not necessarily a delineation of all the actions/duties necessary to the job. Qualifications: Interqual and MCG Guideline experience preferred. Strong communication (written and verbal) and critical thinking skills required. Process redesign, project and change management experience preferred. Knowledge and understanding of managed care contract language, Medicaid, CMS guidelines, and third party payor guidelines preferred.
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