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Manager, Concurrent Review - Tampa Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1101858
Categories:  For-Profit Senior Services
Job Role:  LPN / LVN / Nurse
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: WellCare Health Plans, Inc. (NYSE: WCG) provides managed care services exclusively for government-sponsored health care programs, focusing on Medicare and Medicaid. Our experience and our exclusive commitment to these programs enable us to serve our members and providers as well as manage our operations effectively and efficiently.

A 2008 Fortune 500 company headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children and the aged, blind and disabled, as well as prescription drug plans. The company employs approximately 3,500 associates and serves nearly 2.4 million members nationwide as of March 31, 2011. For more information about WellCare, please visit the Company's website at www.wellcare.com.
The Manager of Concurrent Review manages the activities of the Concurrent Review team.  Provides guidance to associates performing clinical reviews for utilization purposes to include the evaluation of inpatient treatment and clinical progress of members admitted to acute care facilities, skilled nursing facilities and inpatient rehabilitation facilities.  Identifies team goals based on corporate goals and guides associates to ensure goals are met. 

 

Essential Functions:


  • Establishes, implements and monitors work flow processes and outcomes to ensure business goals and contractual requirements are met.

  • Serves as a representative for issues on interdepartmental initiatives.

  • Effectively communicates with internal/external customers to provide information, resolve issues and promote a positive relationship between departments, providers and members.

  • Coordinates department projects and activities to meet budget figures and appropriate deadlines.

  • Oversees the implementation of programs and strategies.

  • Manages process improvement initiatives.

  • Manages all aspects of the interview and selection process on potential candidates.

  • Conducts employee counseling and performs yearly evaluations.

  • Performs special projects as assigned.

Education/Experience: 


  • Registered Nurse/RN Licensed in state of practice (FL).  BSN preferred

  • 5 years experience in a utilization management setting with experience in ER/critical care, discharge planning and bedside care.   

  • 3 years in managed care.

  • 1 years in a management/supervisory position


 

Licenses/Certifications: 


  • FL Licensure Required. 


Computer Skills: 



  • Solid knowledge of email systems such a Microsoft Outlook.



  • Computer proficiency in Microsoft Word and Excel with some knowledge of Microsoft Access preferred.



  • Knowledge of or the ability to learn company approved software such as CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties.

     


Post Date:  02/24/2012

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