RN Mgr, Utilization Management - Post Acute

Summa Health•Akron, OH

48d•$41 - $62•Hybrid

About The Position

We are seeking an experienced (RN) Nurse Manager to lead our post-acute Utilization Management Team in applying InterQual criteria for precertification/authorization. Previous hospital and/or health plan experience with Discharge Planning desired, and knowledge of post-acute admission criteria (SNF, AR, LTAC). This role would be a hybrid position once acclimated, with one day a week onsite with occasional site visits within the area. Summary: Perform duties to conduct and manage the day-to-day operations of the utilization management function for post-acute utilization services. Communicate with staff to facilitate daily department functions including prior authorization for post-acute services related to Long Term Acute Care Hospital (LTACH), Acute Rehabilitation (AR), and Skilled Nursing Facilities (SNF), Discharge Planning and transitions of care. Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs. Meets organizational, operational and service goals related to quality outcomes, member experience, and cost-efficiency.

Requirements

Bachelor's degree or equivalent combination of education and/or experience
Licensed as a Registered Nurse in the state of Ohio
Three (3) years performing post-acute utilization management/ discharge planning activities and minimum of four years relevant clinical experience.
Experience including prior authorizations, post -acute clinical nursing, health plan management, working knowledge of Medicare and/or Commercial plan designs, and/or experience with clinical regulatory and accrediting guidelines preferred
Prior management/leadership experience required, preferably in post-acute areas and/utilization management, or health plan management.
Knowledge of clinical authorization criteria required. Knowledge of InterQual or MCG preferred. Must be knowledgeable of CMS post-acute admission requirement.
Moderate computer skills and familiarity with Outlook, Word, Excel, PowerPoint required. Able to interpret data reports.
Flexible: Ability to adapt to meet business needs.
Access to own vehicle for occasional travel to area post-acute facilities.
Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity
Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.

Nice To Haves

Case Management Certification (CCM, ACM) preferred
Knowledge of Epic preferred

Responsibilities

Perform duties to conduct and manage the day-to-day operations of the utilization management function for post-acute utilization services.
Communicate with staff to facilitate daily department functions including prior authorization for post-acute services related to Long Term Acute Care Hospital (LTACH), Acute Rehabilitation (AR), and Skilled Nursing Facilities (SNF), Discharge Planning and transitions of care.
Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs.
Meets organizational, operational and service goals related to quality outcomes, member experience, and cost-efficiency.