Utilization Management RN (Hybrid) #36461
Clinical Research
Philadelphia, PA Contract To Hire May 24, 2024
Contemporary Staffing Solutions is seeking a dedicated and experienced Utilization Management Registered Nurse (RN) to join our client in Philadelphia, PA! The ideal candidate will possess a strong background in Managed Care, with significant experience in audit, oversight, and case management. This role requires an unrestricted RN license to practice in either New Jersey (NJ) or Pennsylvania (PA). This Contract opportunity offers $36.66-$45/Hour!

Key Responsibilities:
  • Conduct comprehensive audits and continuous monitoring of delegated entities to ensure adherence to federal and state regulations, as well as accreditation standards.
  • Review submitted materials such as policies, files, program documents, and other relevant information for audit purposes.
  • Perform data analysis related to vendor performance, identifying areas for improvement and ensuring compliance.
  • Prepare detailed audit reports and manage the implementation of corrective action plans.
  • Present audit findings and recommendations to the Delegation Oversight Committee.
  • Conduct annual risk assessments to identify and evaluate potential delegation risks.
  • Actively participate in CMS program audits, ensuring thorough preparation and compliance.
  • Demonstrate a strong understanding of Part C Organization Determination guidelines and National Committee for Quality Assurance (NCQA) standards.
  • Collect and organize necessary documents in preparation for audits.
  • Maintain up-to-date knowledge of regulatory changes and best practices in utilization management and managed care.

Qualifications:
  • Unrestricted RN license to practice in New Jersey (NJ) or Pennsylvania (PA).
  • Extensive experience in Managed Care, with a focus on audit and oversight of utilization management and case management.
  • Strong analytical skills, with the ability to conduct data analysis and identify improvement opportunities.
  • Excellent written and verbal communication skills, with experience in writing audit reports and presenting findings.
  • In-depth knowledge of CMS program audits, Part C Organization Determination guidelines, and NCQA standards.
  • Detail-oriented with strong organizational skills, capable of managing multiple tasks and deadlines.

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com.