Team Leader - RN

Minimum of 3 years of utilization management or utilization review experience in an acute care, health plan, or managed care setting preferred.

Demonstrated proficiency in the application and interpretation of InterQual Criteria, including Post Acute Care subsets, to support medical necessity and level of care determinations. Preferred.

Strong knowledge of National Committee for Quality Assurance (NCQA) Utilization Management standards, accreditation requirements, and quality improvement processes. Awareness of Centers for Medicare & Medicaid Services (CMS) regulations a plus, preferred.

Experience leading teams, facilitating collaborative problem-solving, and driving departmental performance outcomes, preferred.

Experience in care coordination or leading teams responsible for care coordination, including collaboration with Care Management and Medical Directors, preferred.

Excellent critical thinking, clinical judgment, and decision-making skills related to utilization management, preferred.

Strong written and verbal communication skills with the ability to effectively interact with physicians, interdisciplinary teams, leadership, and internal and external stakeholders, preferred.

Experience monitoring quality metrics, regulatory compliance, and department performance indicators, preferred.

Ability to build a culture of accountability, engagement, and continuous improvement, preferred.

Demonstrated success in staff coaching, conflict resolution, and change management, preferred.

Strong organizational skills with the ability to prioritize multiple competing demands while meeting regulatory and operational deadlines, preferred.

Commitment to delivering high-quality, patient-centered, and compliant utilization management services, preferred.

" Qualifications "

Associate's Degree in Nursing or RN Diploma required. Bachelor's Degree preferred.

Three (3) to six (6) years clinical experience and two (2) years supervisory experience.

Strong organizational, planning, analytical and communication skills.

Excellent interpersonal skills necessary to interact with all levels of personnel.

Working knowledge of PC applications and/or mainframe systems preferred.

Daily travel to assigned on site facility where applicable. Proof of auto liability coverage for nurses on site where applicable.

Valid current Michigan driver's license and personal means of reliable transportation for nurses on site as applicable.

Other related skills and/or abilities may be required to perform this job.

Registered Nurse with current unrestricted state of Michigan license required.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.