Utilization Review and Clinical Program Manager
About The Position
The Utilization Review and Clinical Programs Manager oversees utilization review activities that support medical necessity, appropriate patient status, denial prevention, and effective use of healthcare resources. The manager conducts medical necessity reviews using MCG criteria, monitors patient status and length of stay, identifies documentation opportunities, and supports payer reviews, denial prevention, and appeals. The position also serves as the designated Trauma Program Manager and Stroke Coordinator, leading and coordinating Lakewood Health System’s trauma and stroke programs. Responsibilities include program compliance, performance improvement initiatives, required reporting, education, and maintaining readiness for program designation. The manager collaborates with Nursing Administration, medical directors, providers, nursing, care management, and other interdisciplinary teams to strengthen clinical processes, support regulatory compliance, improve quality outcomes, and promote patient-centered care. This is a full-time, 1.0 FTE management position in the Nursing Administration department at Lakewood Health System’s Main Campus in Staples, Minnesota.
Requirements
- Current, unrestricted Minnesota Registered Nurse (RN) license.
- Acute care nursing experience, including emergency and trauma care.
- Strong clinical judgment, organizational skills, and attention to detail.
- Excellent communication, documentation review, and interdisciplinary collaboration skills.
- Ability to analyze clinical data, identify opportunities for improvement, and maintain required role-specific competencies.
Nice To Haves
- Experience in utilization review, trauma program management, stroke coordination, care management, or quality improvement.
- Familiarity with MCG criteria, Medicare and Critical Access Hospital requirements, and Minnesota Department of Health trauma and stroke designation standards.
Responsibilities
- Conduct medical necessity reviews using MCG criteria.
- Monitor patient status and length of stay.
- Identify documentation opportunities.
- Support payer reviews, denial prevention, and appeals.
- Serve as the designated Trauma Program Manager and Stroke Coordinator.
- Oversee trauma and stroke program compliance, performance improvement initiatives, required reporting, and education.
- Maintain readiness for trauma and stroke program designation.
- Collaborate with medical directors, providers, nursing, care management, and other departments to improve clinical processes and support regulatory compliance.
- Promote effective resource utilization, quality outcomes, and patient-centered care.
Benefits
- Generous planned time off and wellness time off.
- 401(k) match.
- Annual tuition assistance of $2,000 per year.
- Employer HSA contributions.
- Employer-paid premiums for individual-only healthcare coverage.
- Opportunities for growth within the system.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
