Unit Manager, Utilization Review Nurses
Location: Richmond, Virginia
Description: Hanover Insurance Group is at present looking to employ Unit Manager, Utilization Review Nurses right now, this position will be ordered in Virginia. For complete informations about this position opportunity please read the description below. Job ID #: 4601 Location: Richmond, VA
Functional Area: Claims SBU: 85100 - Risk Management Claims
Position Type:! Full - Time
Education Required: Bachelors Degree
Experience Required: 7 - 10 Years
Relocation Provided: No
Job Description
This position may be based in the following locations. Relocation assistance will be considered.
- Worcester, MA
- Howell, MI
- Itasca, IL
- Syracuse, NY
- Richmond, VA
- Somerset, NJ (or the surrounding areas)
Hanover Insurance is a winning company comprised of outstanding professionals focused on a single vision: to be the very best in our business. At The Hanover you will have the opportunity to: Grow Your Career, Love What You Do and Be Valued for Your Contributions.
Apply today and discover:
- Why, in 2010 and 2011, we were recognized by The Boston Globe as a "Top Places to Work" and by Business Insurance as a "Best Places to Work".
- How we cont! inue to grow stronger through acquisitions, increased product ! offerings and unparalleled credit rating agency upgrades in the industry.
- How we build unique relationships with our Employees, Agent Partners and Customers.
The Hanover Insurance Group is seeking a Unit Manager for our Utilization Review Nurses in the Worcester, MA location
Position Overview/Summary:
Responsible for daily oversight of the Utilization Review team. Manage and lead staff of individuals to achieve the key business strategies of the organization through effective front line utilization management. Engage staff, internal and external customers to ensure medical resolution of injury claims timely and efficiently. Demonstrate the knowledge and skills to deliver effective performance management, communication, relationship building, decision making, and customer service. Responsible for assessing the present and future resource needs for employe! es and provide the leadership, mentoring and guidance necessary to build and sustain a high performing workforce.
Responsibilities/Essential Functions:
Ongoing activities associated with work product quality
Accountable for a team of individuals responsible for reviewing proposed treatment to certify medical necessity of care according to approved criteria/guidelines, referring all cases that do not meet medical necessity criteria/guidelines to a physician consultant for review, complying with individual state legislation when applicable regarding length of treatment guidelines, appeal time frames, special levels of appeal and Utilization Review Accreditation Council (URAC), identifying potentially fraudulent claims and subrogation opportunities
Alerts claim adjusters to cases that may benefit from nurse case management services
Accountable for monitoring and assessing employee performance.
Provide feedback and coaching and take appropria! te action.
Solicit and act on internal customer feedback on escalat! ed issues.
Talent/Performance Management
Responsible to monitor volume and business plans, make timely staffing recommendations within established models and participate in identifying the ideal candidate.
Responsible to identify and provide developmental opportunities through coaching and mentoring.
Recognizes opportunities for technical and industry training as part of a personal and professional development program.
Work with employees on performance management by setting cascading goals, giving and receiving feedback, documenting and delivering performance reviews, addressing performance issues, creating and implementing development plans while conforming to policies and other internal procedures.
Responsible for salary administration recommendations that are directly linked to individual performance.
Utilizes technology and talent management to increase efficiency and scalability to support corporate growth and service initiatives. Dail! y oversight of resources, workflow and processes
Direct day to day operations which include tracking measures, analyzing reports, and reinforcing goals.
Develop, recommend and implement continuous improvement initiatives which result in cost effective enhancements in quality and service. Builds positive relationships with internal/external customers to accomplish organizational goals
Identify key issues and communicate to the proper audience in an appropriate and timely manner.
Act as an expert resource for direct reports, other teams, business units and claims leadership.
May lead and/or participate in initiatives that support claims strategies and financial goals.
Essential Skills and Experience:
Registered Nurse with current state licensure
Clinical experience in applicable nursing specialty field (i.e. occupational health, rehabilitation, orthopedics, home care, emergency)
Expert knowledge of utilization review process, me! dical bill review and/or medical case management
Management skills ! a plus
Ability to collaborate and work effectively in a team environment
Strong analytical, problem solving and negotiation skills
Effective interpersonal communication and writing skills
Organization skills with regard to time management, task prioritization, and integration of information from a variety of sources
Ability to determine and meet internal and external customer needs
Word processing skills
Knowledge of technical materials, rules, procedures or facts required to effectively perform the role such as : utilization criteria (ODG, MA DIA Guidelines, Rhode Island Guidelines, etc.), medical coding mechanisms( ICD-9 CM, CPT-4, DSM-IV), case management standards of practice, state workers' compensation and personal injury protection (PIP) regulations
Ability to adapt to a dynamic work environment
PC/ Keyboard skills
Benefits To Joining The Hanover Team:
Competitive Pay and Benefits
Retirement/401(k) Program Beneficiary and Ability Assist Programs
Travel Assistance Program
Adoption Benefit
Wellness Programs
Matching Education Gifts Plan
Employee Development/Education Assistance and
Professional/Industry Designation Programs
Generous 'Time Off With Pay'
The Hanover Insurance Group, Inc. (NYSE: THG), based in Worcester, Mass., is the holding company for a group of insurers that includes The Hanover Insurance Company, also based in Worcester; Citizens Insurance Company of America, headquartered in Howell, Mich., and their affiliates. The Hanover offers a wide range of property and casualty products and services to individuals, families and businesses through an extensive network of independent agents, and has been meeting its obligations to its agent partners and their customers for more than 150 years. Taken as a group, The Hanover ranks among the top 40 property and casualty insurers in the United States.
EEO Statement
! The Hanover Insurance Group provides equal opportunity for employment a! nd promotion to all qualified employees and applicants. No person shall be discriminated against in employment on the basis of race, color, religion, gender, age, national origin, marital status, disability, sexual orientation, veteran status or any other status of condition protected by applicable federal or state statutes. The company is willing to provide reasonable accommodation to all qualified disabled persons in order to assist them in performing the essential functions of their position. The Company is committed to maintaining an environment in which all employees are treated equitably and given the opportunity to achieve in the workplace.
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If you were eligible to this position, please give us your resume, with salary requirements and a resume to Hanover Insurance Group.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be started on: Mon, 24 Jun 2013 09:31:33 GMT
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