Clinical Review Unit Manager

State of Arizona - Phoenix, AZ

Job Title: Clinical Review Unit Manager

Position: Manager of Division of Fee for Service Management Clinical Review Unit

Job Type: Full Time

Pay: $83,600

Shift:

Work Type: Remote, within Arizona

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Provide direct management of the Clinical Review Unit and manage the nursing staff and non-nursing staff.
Participate in Division and Agency Policy Committees.
Oversee and direct the technological aspects of the Clinical Review Unit processes and maintain reporting structures and processes.
Provide oversight and direct team interaction with Fee-for-Service (FFS) Providers and stakeholders.
Ensure provider issue resolution including grievance and appeals, and provide technical assistance.
Work in conjunction with other clinical teams in the DFSM and external partners on quality-related matters.
Oversee team's participation in special processes such as SMI or SED determination and other special needs.
Act as a FFS subject matter expert while assisting in the development of policies and procedures.

Required Skills

Core Skills

Knowledge of medical terminology, CPT, and ICD procedural coding.
Knowledge of industry standards for retrospective utilization review.
Skills in teaching and organizational management.
Excellent oral and written communication.
Strong interpersonal and management skills.

Preferred Skills

Certification as a professional CPT coder.
Experience in medical coding/billing.
Professional experience in health care industry review and management.

Requirements

Experience: Four (4) years professional experience related to health programs and two (2) plus years of managerial experience.

Education: Possession of a current license to practice as a registered nurse in the State of Arizona; a Master's degree may substitute for one year of experience.

License & Certification:

Current license to practice as a registered nurse in Arizona.

Schedule:

Not specified

COVID-19 Requirements: Not Specified

Benefits

10 paid holidays per year.
Paid Vacation and Sick time off - 13 and 12 days per year respectively.
Paid Parental Leave - Up to 12 weeks per year for newborn or newly-placed foster/adopted child.
Top-ranked retirement program with lifetime pension benefits.
Robust insurance plan, including medical, dental, life, and disability insurance.
Participation eligibility in the Public Service Loan Forgiveness Program.
RideShare and Public Transit Subsidy.
A variety of learning and career development opportunities.