Manager, Utilization Review

Children's Mercy KC • Kansas City, MO

12d • $44 • Onsite

About The Position

Thanks for your interest in Children's Mercy! Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years. Children’s Mercy is in the heart of Kansas City – a metro abounding in cultural experiences, vibrant communities and thriving businesses. This is where our patients and families live, work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in children’s health, we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital. Overview To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/appeals oversight. Participates in department and hospital performance improvement activities; Responsible for outcomes reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family centered care management and services. At Children’s Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity. Additionally, it’s important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children’s Mercy staff, we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you are selected for this position, you will be asked to supply your immunization records as proof of vaccination. If you and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

Requirements

• Bachelor's Degree in nursing and 3-5 years experience Experience in Utilization Review
• Master's Degree in nursing required within 4 years of hire
• 1-2 years experience Experience in Utilization Review
• One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire
• One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire
• RN Compact license for all states besides KS and MO Must obtain KS or MO Compact within 60 days of hire
• One of the following: American Case Management, Certified Case Manager required upon hire
• Employees must obtain American Case Management or equivalent within 730 days
• Employees must obtain Certified Case Manager or equivalent within 730 days
• Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire

Responsibilities

• Personnel management
• Participates in department and organization performance improvement activities
• Department management and program development
• Assists the department Director with fiscal management and accountability

Benefits

• The benefits plans at Children’s Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families. Learn more about Children’s Mercy benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees