Deskripsi Pekerjaan
Join our dynamic healthcare team as a USRN Team Lead where you'll drive excellence in utilization review processes. This pivotal leadership role combines your clinical expertise with strategic team management to ensure optimal patient outcomes and operational efficiency. You'll spearhead a team of healthcare professionals while maintaining strict compliance with InterQual or MCG criteria in fast-paced hospital environments. Your leadership will directly impact quality assurance, resource optimization, and regulatory compliance across complex medical cases.
As a key stakeholder, you'll collaborate with multidisciplinary teams to resolve complex utilization scenarios, mentor junior staff on best practices, and implement process improvements. This opportunity offers competitive compensation in a growth-oriented setting where your nursing leadership skills will transform healthcare delivery. Bring your passion for patient advocacy and operational excellence to lead our next generation of utilization review specialists.
Tanggung Jawab
- Lead and mentor a team of Utilization Review Nurses (URNs) to achieve performance targets
- Ensure compliance with InterQual or MCG criteria for all utilization reviews
- Oversee complex case reviews and provide expert clinical guidance
- Develop and implement process improvements for utilization review workflows
- Collaborate with healthcare providers and insurance companies on case resolutions
- Monitor team performance metrics and implement corrective actions
- Train team members on regulatory updates and best practices
Kualifikasi
- Active USRN License (New York License strongly preferred)
- Minimum 1 year experience as Utilization Review Team Lead
- Proficiency with InterQual or MCG criteria systems
- Proven leadership experience in hospital or BPO environments
- Strong clinical background in utilization review processes
- Excellent communication and problem-solving abilities
- Ability to thrive in fast-paced healthcare settings