Managed Care Manager - RN
Who we are:
Since 1981 we have been transforming the life of thousands. We are looking to continue helping more members of our community. We are now expanding and looking to build a bigger and stronger team of empathetic and caring mental health professionals.
Essential Requirements:
As a Managed Care Manager (RN), you will work with referral sources from the healthcare community to plan and direct services to meet the needs of individuals while assessing medical necessity in accordance with Medicaid and Medicare guidelines. The Managed Care Manager will oversee a team of healthcare staff to ensure provision of high-quality healthcare services and proper transition of care.
- Responsible for providing support and direct supervision of healthcare staff.
- Responsible for scheduling, evaluating, ongoing staff development, team meetings, and individual supervisory meetings.
- Review inpatient requests from facilities, hospitals, and work with the Chief Medical Officer (CMO) in the concurrent medical review process.
- Works with healthcare staff to obtain appropriate clinical documentation for review of medical necessity by payors.
- Discusses transitions of care and discharge planning with healthcare staff.
- Adheres to established policy and procedure and standards of care; escalates issues through the established of command timely.
- Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect, and Expertise).
- Participates in revising the plan of care for individuals, as necessary.
- Assists with processing denials and ensuring medical necessity is effectively documented and diagnosis is to the highest specificity.
- Perform all other duties relevant to the position as assigned.
Qualifications: Active and unrestricted licensure as a Registered Nurse in Florida. Excellent time management and organizational skills and experience establishing guidelines in these areas for others.
Education and/or Experience:
-Graduate from an accredited school of nursing, or Bachelor’s (or advanced) degree in nursing. A minimum of three to 5 years clinical experience as a Registered Nurse in a behavioral health setting required. Two years’ experience as a utilization management nurse in a managed care payor preferred.
Benefits Highlights
Retirement: 403B plan matching up to 5%
Balance: Competitive Vacation and PTO plan, 11 paid Holidays.
Development: Leadership development, personal and professional growth.
Culture: Loved and faith-based mission, respect to diversity; going through expansion and growth.
Our Mission is to “Restore individuals and families to psychological, social, physical, and Spiritual health.”
Agape Network is an Equal Opportunity Employer and a Drug-Free Workplace.
Job Type: Full-time
Pay: $75,000.00 - $85,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Standard shift:
Weekly schedule:
Ability to Relocate:
- Miami, FL 33170: Relocate before starting work (Required)
Work Location: In person