Utilization Review Manager
About The Position
Purpose & Scope: The Utilization Review Manager oversees the utilization review process, ensuring efficient and effective use of hospital resources, compliance with regulatory requirements, and optimal patient care. The Utilization Review Manager will: Manage the utilization review team and processes. Conduct reviews of patient care and resource utilization. Collaborate with healthcare providers and hospital staff. Ensure compliance with regulatory requirements and accreditation standards. Analyze data to identify trends and opportunities for improvement. Develop and implement strategies to optimize resource utilization and patient care.
Requirements
- Bachelor's of Nursing is required
- Three (3) years Utilization Review management experience; hospital and/or insurance considered.
- Licensed as a Registered Nurse with the Virginia Department of Health Professions is required, or,
- Compact State Nursing License is required.
Responsibilities
- Manage the utilization review team and processes.
- Conduct reviews of patient care and resource utilization.
- Collaborate with healthcare providers and hospital staff.
- Ensure compliance with regulatory requirements and accreditation standards.
- Analyze data to identify trends and opportunities for improvement.
- Develop and implement strategies to optimize resource utilization and patient care.
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What This Job Offers
Career Level
Manager
Industry
Hospitals
Number of Employees
5,001-10,000 employees
