Manager Utilization Review- RN

The Christ Hospital Health Network • Cincinnati, OH

4d

About The Position

The Manager, Utilization Review-RN oversees hospital utilization review functions. This role is responsible for the planning, operations, and daily oversight of the department to facilitate the highest quality, cost-effective care and appropriate case status based on evidence-based criteria. This position oversees department alignment with payer policy and revenue cycle processes. The manager should support appropriate use of healthcare resources, regulatory compliance, and safe, efficient patient transitions across the continuum of care.

Requirements

• Registered Nurse (RN) license.
• Experience in utilization review.
• Knowledge of payer policies and revenue cycle processes.
• Understanding of evidence-based criteria.
• Familiarity with healthcare resource management.
• Knowledge of regulatory compliance.
• Experience in patient transitions across the continuum of care.

Responsibilities

• Planning, operations, and daily oversight of the utilization review department.
• Facilitating the highest quality, cost-effective care.
• Ensuring appropriate case status based on evidence-based criteria.
• Overseeing department alignment with payer policy and revenue cycle processes.
• Supporting appropriate use of healthcare resources.
• Ensuring regulatory compliance.
• Facilitating safe, efficient patient transitions across the continuum of care.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed