BSN Utilization Review Travel Nursing Jobs South Dakota for Case Management/Utilization Reviews

POSITION SUMMARY Director Continuity of Care Service POSITION DUTIES Manages the overall, regionwide utilization management function ensuring the accurate and timely prior authorization of designated healthcare services. Oversees the concurrent, discharge planning and retrospective review activities for the Colorado region. Manages utilization review staff. MINIMUM REQUIRED QUALIFICATIONS·       Minimum eight (8) years clinical and medical utilization/review experience. ·       Minimum five (5) years supervisory/management experience. PREFERRED QUALIFICATIONS·       Thorough knowledge of utilization management and clinical practice. ·       Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. ·       Knowledge of regulatory/accreditation requirements (NCQA, DMHC, DHCS, CMS, Medi-Cal Plan Partners, Special Needs Plan (SNP). LENGTH OF ASSIGNMENT SHIFT / HOURS PER WEEK SYSTEMS START DATE