Manager Utilization Review
About The Position
The Manager of Utilization Review is responsible for overall policy and operational accountability for utilization review to meet system strategic goals and directions. This position oversees utilization for all patient encounters. This includes management of the department budget, hiring and performance management. The manager is responsible for supporting the educational and training needs of staff with day-to-day operations and supervision, as well as assisting the System Director with strategic planning and implementation of newly revised processes. Requires an active participation in process improvement, JCAHO preparedness, payor collaboration and other hospital committees. The Manager of Utilization Review works closely with each entity and system leadership. Experience: Managerial experience in utilization review in hospital setting. Experience with implementing and overseeing a utilization review program. Extensive knowledge of reimbursement mechanisms, denial prevention and clinical utilization management. Working knowledge of state and federal government regulations such as RAC/MAC, 2 Midnight Rule, readmissions, efficiency of care across the continuum and accountable care organization models. Requirements include BSN in Nursing, Registered Nurse Missouri and Kansas License and 3-5 years experience in Utilization Review.
Requirements
- Managerial experience in utilization review in hospital setting
- Experience with implementing and overseeing a utilization review program
- Extensive knowledge of reimbursement mechanisms, denial prevention and clinical utilization management
- Working knowledge of state and federal government regulations such as RAC/MAC, 2 Midnight Rule, readmissions, efficiency of care across the continuum and accountable care organization models
- BSN in Nursing
- Registered Nurse Missouri and Kansas License
- 3-5 years experience in Utilization Review
Responsibilities
- overall policy and operational accountability for utilization review
- oversees utilization for all patient encounters
- management of the department budget
- hiring and performance management
- supporting the educational and training needs of staff
- day-to-day operations and supervision
- assisting the System Director with strategic planning and implementation of newly revised processes
- active participation in process improvement, JCAHO preparedness, payor collaboration and other hospital committees
- works closely with each entity and system leadership
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
1,001-5,000 employees
