ConcertoHealth delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.
The ConcertoHealth name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.
This position is responsible for promoting the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to review of LTSS.
Education: Bachelor’s Degree required.
Experience: Minimum of two years of experience in assessing individuals for Home and Community Based Waiver Services and Personal Care Services. Experience in evaluating clinical records and documentation related to LTSS. Four (4) years’ utilization management experience preferred. Must possess a strong understanding of Managed Care principles. License / Certification: Requires a valid, unrestricted state nursing license (RN or LVN), or Social Work license. Computer Skills: Basic computer skills in a Windows operating environment including Microsoft Word, Excel, and an e-mail system. Knowledge / Skills / Abilities: High energy; demonstrates an ability to function in a creative, entrepreneurial environment and “think outside the box.”
Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management.
Knowledge of healthcare delivery and management.
Able to demonstrate strong knowledge of the authorization review process and workflow.
Intermediate computer literacy (MS Office) and typing skills are necessary.
Strong interpersonal and decision-making skills; must be able to introduce new ideas, processes, and tools to improve department performance.