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RN Utilization Review Manager - UC Health Business Center - Util
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-89829158

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UC Health

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  Job posted:   Fri May 18, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
RN Utilization Review Manager - UC Health Business Center - Util
*Utilization Review Manager*
*UC Health Business Center*
*Utilization Review/Denials Management*
*Full Time*
*Primary Purpose:*The Manager of Utilization Review is responsible for the effective utilization review processes, including management of patient statusing processes, ongoing monitoring of medical necessity review functions for UCMC. The Manager will work with the director to develop and implement quality review programs and key performance indicators for all UR activities. The Manager interacts with Medical, Nursing, and Executive leadership to facilitate quality based, cost effective, patient statusing in the most appropriate setting, and compliance with regulatory and revenue cycle requirements related to utilization review. The Manager is responsible for day-to-day operations of the department, assists with the budgeting process, assists with personnel recruitment, retention, corrective action and professional development.

*Knowledge and Skills*

*Education*: BSN minimum required.

*Years of Experience*: 5 Years equivalent experience minimum required.

*Required Skills and Knowledge*: Knowledge of and ability to apply clinical decision support/medical necessity criteria. Current knowledge of rules, regulations, policies and procedures related to JCAHO, CMS and other regulatory, licensing, and accrediting agencies required. Knowledge and training in multiple computer systems required to perform position responsibilities (i.e. EPIC, Microsoft Office, Midas, etc.) Experience in an academic medical center or multi-hospital system preferred. Effective interpersonal skills to work with a wide range of personalities while working collaboratively in a self-directed detailed oriented work environment. Remains poised under stress. Strong organizational skills to manage multiple, complex activities with tight deadlines, establish priorities and manage time effectively. Effective written and verbal communication skills required for establishing and maintaining relationships with physicians, supervisors, peers, subordinates, patients, and payers. Demonstrate initiative and responsibility for professional nursing practice. Effective conflict resolution and negotiation skills.

*License and Certifications*: Current RN License in Ohio. Certification in Utilization Review or Case Management strongly preferred.

**Organization:** **UC HEALTH (INC.)*

**Title:** *RN Utilization Review Manager - UC Health Business Center - Utilization Review/Denials Management*

**Location:** *UC Health Business Center - 3200 Burnet Ave - Cincinnati, OH*

**Requisition ID:** *048414*

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