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Nurse Manager
MI - East Lansing
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Opportunity Snapshot
This position offers you the opportunity not only to play a key role as part of the ground floor team launching a new program integrity contract for the state of Michigan, but also to join a thriving, fast growing national company. You will enjoy the "best of both worlds:" the clinical sophistication of Permedion, a recognized leader in the assessment of healthcare services, and the resources and stability of Health Management Services (HMS), our parent corporation, just ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies. We're currently assembling a compelling proposal, including top quality staff members who can hit ground running once the contract is awarded.
You will recruit, train and supervise a team of nurses providing a variety of services, including prior authorization, audits and utilization reviews for inpatient, outpatient, emergency, and long term care facilities. To be a good fit for this opportunity you will have an active, unrestricted Michigan RN license, a solid clinical background and demonstrated management/supervisory experience. We're looking for a professional familiar with utilization management, ideally including long term care, as well as experience with customer service and provider relations. Not only will you need to be flexible and adaptable as we implement this program, but you also will need the leadership skills to help your people be the same.
For 35 years Permedion, an HMS company, has provided external medical peer reviews and independent health care review services for government agencies and large health care providers. Permedion is accredited by URAC in both Independent Review and Utilization Management. Founded in 1985, HMS offers one of the broadest portfolios of service to help government-sponsored healthcare plans recover billions of dollars and save billions more through cost avoidance. While others are cutting back, HMS is growing: our 2008 revenues of $184 million were up more than 20% over 2007, and that rate of growth has persisted through the first half of 2009.
What Else You'll Bring to the Table
In addition to the qualifications detailed above, you'll need:
Solid project management experience.
Demonstrated experience in and successful application of customer service and public relations skills.
Demonstrated leadership skills and successful experience working in an interdisciplinary team environment.
Excellent interpersonal skills with a customer service orientation.
Superior oral and written communication and presentation skills.
Knowledge in and successful application of:
Coaching and delegation skills.
Team activities skills.
Basic level health care data analysis skills.
Needs assessments skills.
Quality improvement skills in developing and implementing quality improvement programs.
Adult education principles and behavioral change techniques.
Basic personal computer skills, including using word processing and spreadsheet software as well as generating reports.
A demonstrated ability to effectively manage multiple priorities and multi-level tasks.
Preferred but not required:
A bachelor's degree (BA/BS) from a four-year college or university in Nursing, Health Care Administration, or related field
Experience with programs related to the Medicare Modernization Act or Medicaid Management Information Systems.
What's in It for You
Make your mark -- while this program will take advantage of HMS/Permedion's portfolio of best practices, systems and resources (we've been operating in Michigan since 1995), you will influence the unique implementation and ongoing growth of this program, including building and developing your team.
Growth = opportunities for proven leaders -- our strategy is to prove our ability to exceed clients' expectations, and leverage that track record to grow. In addition to working to expand this contract down the road, we'll actively look for new areas in which we can help the state of Michigan achieve its goals. As we grow so will our need for those people with both clinical expertise and demonstrated leadership skills.
Clinical sophistication through continuous improvement -- our URAC accreditation requires that we maintain continuous organizational improvement processes, and we never stop learning and growing. This spirit has enabled us to achieve industry recognition for our expertise. For example, we are designated by the Centers for Medicare and Medicaid Services (CMS) as one of eight Qualified Independent Contractors (QIC) in the US, meaning CMS acknowledges that we have the expertise and capabilities to perform appeals of Medicare claims between the carrier and Administrative Law Judge levels.
No signs of slowing -- Medicaid and Medicare budgets are growing (CMS predicts current Medicare/Medicaid spending levels to double by 2015) and, with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Permedion and HMS are taking advantage of this climate to drive solid growth. In addition to posting double-digit growth year over year since 2001, HMS is successfully expanding into new markets, including federal healthcare and managed care.
Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes 401(k) plan with generous employer match, flexible spending plans, and much more.
More About Your Role
HMS Permedion will submit a proposal, by September 22, 2009, to provide the Michigan Department of Community Health with program integrity services, including utilization management and auditing. The contract stipulates a program start date of January 1, 2010, meaning ramp-up will be short. In addition to the professionals coming on board in facilities in East Lansing, the program will take advantage of support and resources from other areas of Permedion.
Reporting to the Program Director, you will hire, train and supervise a team of seven to nine people, including Nurse Reviewers and possibly Intake Coordinators, Coding Specialists and administrative support. You'll organize this staff to handle:
Inpatient hospital prior authorization.
Inpatient, outpatient, and emergency room hospital audits and utilization review.
Long term care immediate and exception reviews.
Long term care retrospective eligibility reviews.
As you may know, Michigan does not allow the same individual to work among different areas of review, so one of your early tasks will be to divide the group into small specializing teams. You may also do hands-on reviews yourself. Some of the nurses will work on site at various clinical facilities to copy/scan records, etc. The actual staffing may be flexible regarding the number of staff and the mix of full and part time staff, in order to accommodate changes in the volume of work.
You also will interact regularly with our physician panel, located in our Ohio headquarters. Prior to program launch and as the program gets up to speed you will participate in meetings with state contacts.
Your specific activities will include:
Hiring, training, and orienting staff.
Supervising Nurse Reviewers, Intake Coordinators, and Coding Specialists.
Interfacing with clients regarding status reports, work planning, policy interpretation, and defending decisions in the provider appeals process.
Insuring internal quality control for each direct report to be certain that the job requirements are met.
Insuring all client deliverables are met in a timely fashion.
Keys to Success
Building a program from scratch takes a special kind of leader, one who can combine clinical knowledge, organizational skills, and the leadership and motivational skills to take a team to ever-higher levels of performance. To excel in this role you will be comfortable with a degree of ambiguity as you help create the structure that will set us up for success in executing this contract beyond our client's expectations.
If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!
Who We Are
Permedion provides external medical peer reviews and independent health care review services for government agencies and large health care providers, helping them control escalating health care costs while providing appropriate medical care. Our three primary areas of service are health care quality measurement and improvement, data analysis and management, and independent medical review.
With a unique combination of statistical and clinical expertise, Permedion works with government agencies, managed care organizations, and other payors to review, measure and improve health care quality. Our staff includes physicians, nurses, epidemiologists and data analysts, systems experts, and health administration experts. Our partners and customers include health plans, physician groups, government agencies, and professional associations.
Permedion is a wholly owned subsidiary of Health Management Systems, Inc. (HMS), providing clinical expertise to all HMS service lines. HMS is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more.
Opportunity Snapshot
This position offers you the opportunity not only to play a key role as part of the ground floor team launching a new program integrity contract for the state of Michigan, but also to join a thriving, fast growing national company. You will enjoy the "best of both worlds:" the clinical sophistication of Permedion, a recognized leader in the assessment of healthcare services, and the resources and stability of Health Management Services (HMS), our parent corporation, just ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies. We're currently assembling a compelling proposal, including top quality staff members who can hit ground running once the contract is awarded.
You will recruit, train and supervise a team of nurses providing a variety of services, including prior authorization, audits and utilization reviews for inpatient, outpatient, emergency, and long term care facilities. To be a good fit for this opportunity you will have an active, unrestricted Michigan RN license, a solid clinical background and demonstrated management/supervisory experience. We're looking for a professional familiar with utilization management, ideally including long term care, as well as experience with customer service and provider relations. Not only will you need to be flexible and adaptable as we implement this program, but you also will need the leadership skills to help your people be the same.
For 35 years Permedion, an HMS company, has provided external medical peer reviews and independent health care review services for government agencies and large health care providers. Permedion is accredited by URAC in both Independent Review and Utilization Management. Founded in 1985, HMS offers one of the broadest portfolios of service to help government-sponsored healthcare plans recover billions of dollars and save billions more through cost avoidance. While others are cutting back, HMS is growing: our 2008 revenues of $184 million were up more than 20% over 2007, and that rate of growth has persisted through the first half of 2009.
What Else You'll Bring to the Table
In addition to the qualifications detailed above, you'll need:
Solid project management experience.
Demonstrated experience in and successful application of customer service and public relations skills.
Demonstrated leadership skills and successful experience working in an interdisciplinary team environment.
Excellent interpersonal skills with a customer service orientation.
Superior oral and written communication and presentation skills.
Knowledge in and successful application of:
Coaching and delegation skills.
Team activities skills.
Basic level health care data analysis skills.
Needs assessments skills.
Quality improvement skills in developing and implementing quality improvement programs.
Adult education principles and behavioral change techniques.
Basic personal computer skills, including using word processing and spreadsheet software as well as generating reports.
A demonstrated ability to effectively manage multiple priorities and multi-level tasks.
Preferred but not required:
A bachelor's degree (BA/BS) from a four-year college or university in Nursing, Health Care Administration, or related field
Experience with programs related to the Medicare Modernization Act or Medicaid Management Information Systems.
What's in It for You
Make your mark -- while this program will take advantage of HMS/Permedion's portfolio of best practices, systems and resources (we've been operating in Michigan since 1995), you will influence the unique implementation and ongoing growth of this program, including building and developing your team.
Growth = opportunities for proven leaders -- our strategy is to prove our ability to exceed clients' expectations, and leverage that track record to grow. In addition to working to expand this contract down the road, we'll actively look for new areas in which we can help the state of Michigan achieve its goals. As we grow so will our need for those people with both clinical expertise and demonstrated leadership skills.
Clinical sophistication through continuous improvement -- our URAC accreditation requires that we maintain continuous organizational improvement processes, and we never stop learning and growing. This spirit has enabled us to achieve industry recognition for our expertise. For example, we are designated by the Centers for Medicare and Medicaid Services (CMS) as one of eight Qualified Independent Contractors (QIC) in the US, meaning CMS acknowledges that we have the expertise and capabilities to perform appeals of Medicare claims between the carrier and Administrative Law Judge levels.
No signs of slowing -- Medicaid and Medicare budgets are growing (CMS predicts current Medicare/Medicaid spending levels to double by 2015) and, with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Permedion and HMS are taking advantage of this climate to drive solid growth. In addition to posting double-digit growth year over year since 2001, HMS is successfully expanding into new markets, including federal healthcare and managed care.
Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes 401(k) plan with generous employer match, flexible spending plans, and much more.
More About Your Role
HMS Permedion will submit a proposal, by September 22, 2009, to provide the Michigan Department of Community Health with program integrity services, including utilization management and auditing. The contract stipulates a program start date of January 1, 2010, meaning ramp-up will be short. In addition to the professionals coming on board in facilities in East Lansing, the program will take advantage of support and resources from other areas of Permedion.
Reporting to the Program Director, you will hire, train and supervise a team of seven to nine people, including Nurse Reviewers and possibly Intake Coordinators, Coding Specialists and administrative support. You'll organize this staff to handle:
Inpatient hospital prior authorization.
Inpatient, outpatient, and emergency room hospital audits and utilization review.
Long term care immediate and exception reviews.
Long term care retrospective eligibility reviews.
As you may know, Michigan does not allow the same individual to work among different areas of review, so one of your early tasks will be to divide the group into small specializing teams. You may also do hands-on reviews yourself. Some of the nurses will work on site at various clinical facilities to copy/scan records, etc. The actual staffing may be flexible regarding the number of staff and the mix of full and part time staff, in order to accommodate changes in the volume of work.
You also will interact regularly with our physician panel, located in our Ohio headquarters. Prior to program launch and as the program gets up to speed you will participate in meetings with state contacts.
Your specific activities will include:
Hiring, training, and orienting staff.
Supervising Nurse Reviewers, Intake Coordinators, and Coding Specialists.
Interfacing with clients regarding status reports, work planning, policy interpretation, and defending decisions in the provider appeals process.
Insuring internal quality control for each direct report to be certain that the job requirements are met.
Insuring all client deliverables are met in a timely fashion.
Keys to Success
Building a program from scratch takes a special kind of leader, one who can combine clinical knowledge, organizational skills, and the leadership and motivational skills to take a team to ever-higher levels of performance. To excel in this role you will be comfortable with a degree of ambiguity as you help create the structure that will set us up for success in executing this contract beyond our client's expectations.
If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!
Who We Are
Permedion provides external medical peer reviews and independent health care review services for government agencies and large health care providers, helping them control escalating health care costs while providing appropriate medical care. Our three primary areas of service are health care quality measurement and improvement, data analysis and management, and independent medical review.
With a unique combination of statistical and clinical expertise, Permedion works with government agencies, managed care organizations, and other payors to review, measure and improve health care quality. Our staff includes physicians, nurses, epidemiologists and data analysts, systems experts, and health administration experts. Our partners and customers include health plans, physician groups, government agencies, and professional associations.
Permedion is a wholly owned subsidiary of Health Management Systems, Inc. (HMS), providing clinical expertise to all HMS service lines. HMS is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
