Medical Utilization Manager - Hybrid in NJ bei Medlogix, LLC

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Fully understand the products and procedures of the organization
• Ensure that employees follow the organization’s policies and procedures, e.g. sick time, personal leave, overtime, etc.
• Ensure department compliance with company philosophy to include objectives, goals and procedures
• Oversee the Pre-cert workflows and in-boxes to ensure statutory compliance is being met, coordinate with supervisors to determine necessary assignments and changes when compliance is in jeopardy
• Plan, control and coordinate clinical and clerical workflows within the department in order to maintain the highest customer service and technical standards
• Work with Supervisors and team leads to set performance standards for tasks, jobs and roles of their employees
• Evaluate and provide guidance to staff on an ongoing basis as to their abilities and duties, make personnel recommendations to ensure proper and optimum use of personnel
• Recommend procedural job changes and plans, organize and implement these changes in accordance with state and company guidelines
• Ensure continuous professional development of staff
• Supervise training and cross-training of all staff
• Perform back-up to pre-cert production when needed
• Perform back-up to Vital Point Pharmacy when needed
• Recruit and select appropriate clinical and clerical applicants for department, provide orientation support to Precertification Supervisory Staff
• Compose annual performance evaluation for direct reports (supervisors)
• Assist supervisors in composing written and verbal discipline warnings
• Provide coverage (supervisory and payroll) for the supervisors in their absence
• Provide ongoing technical support to associates within their job description
• Conduct weekly staff meetings with direct reports (supervisors)
• Conduct and participate in monthly/PRN staff meetings with clinical and clerical staff
• Ensure maintenance of all administrative records for management staff which include performance reviews, attendance and disciplinary documentation
• Assist with timely completion of the QA process as needed
• Ensures the unit has proper and correct amounts of equipment to perform jobs effectively, monitor working condition of equipment
• Coordinate and act as a liaison with other supervisors, managers or branches with whom the department interacts
• Mediate complaints and disputes generated from employees, insured’s, medical providers, claimants and outside vendors
• Provide weekly updates to the VP that outlines objectives, tasks, staffing and departmental concerns
• Participates as a member of the Quality Assurance Committee
• Perform special projects at the direction of the VP
• File review when needed for Arbitrations

EXPERIENCE:

• Must be a Registered Nurse with 3-5 years of Med-Surg experience
• Must have an active RN license
• Must have 3-5 years of leadership experience
• Knowledge of New Jersey PIP preferred
• Utilization Review experience preferred

EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.