Manager, Registered Nurse – Utilization Management

🔥 vor 5 Stunden

🌽 Illinois, Oklahoma, +2 weitere Bundesländer – Remote

🌽 Illinois – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote

⏰ Vollzeit

🟠 Senior

🔴 Experte

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SSM Health

WebsiteLinkedInAlle Stellen

10.000+ Mitarbeiter

Gegründet 1872

🏥 Gesundheitswesen

🤝 Non-Profit

💰 Grant im 2023-12

Healthcare • Non-profit

SSM Health ist ein katholisches, gemeinnütziges Gesundheitssystem, das Gemeinschaften im Mittleren Westen der USA durch ein integriertes Netzwerk von Krankenhäusern, Kliniken und Pflegediensten versorgt. Mit Standorten in Illinois, Missouri, Oklahoma und Wisconsin bietet SSM Health Akutpflege- und Spezialdienste (einschließlich Lehrkrankenhäuser und Level-One-Traumazentren) an und legt Wert auf zielorientierte, mitfühlende Pflege, Personalentwicklung sowie Mitarbeiterbenefits und unterstützt flexible Pflege- und andere klinische Rollen.

Beschreibung

• Oversee system-wide day-to-day operational management of Utilization Management activities and services • Develop and lead a high-performing Utilization Management team • Manage department operations, including referrals, medical necessity reviews, experimental/investigational reviews, and application of medical policies and business processes • Ensure quality and accuracy of Utilization Management review decisions and adherence to departmental policies • Participate in policy development and oversee staff activities for regulatory and accrediting compliance • Oversee staffing and productivity and adjust staffing patterns to maintain adequate operational coverage • Monitor and adhere to the budget and approve or monitor expenditures and purchases • Ensure the UM team meets performance metrics and work plan requirements • Represent UM on committees, task forces, work groups, and multidisciplinary teams • Assist with development, maintenance, and adherence of UM programs and processes • Participate in company and department goals, including quality improvement activities • Recruit, engage, develop, lead, and manage assigned staff • Perform other duties as assigned

🎯 Anforderungen

• Extensive Utilization Management or Case Management experience • Strong understanding of CMS, Medicare & Medicaid, and Commercial regulations • Experience leading large cross-functional teams at a management level • Experience leading denials and appeals resolutions • Experience analyzing denial, authorization, and utilization data to identify trends and improvement opportunities • Ability to embrace change and promote continuous improvement • Effective leadership through evolving priorities and organizational initiatives • Ability to foster accountability, collaboration, adaptability, and engagement • Ability to serve as a trusted partner to staff, physicians, and operational leaders • Bachelor's degree in nursing • Two years of acute nursing registered nurse experience • Five years of utilization management experience • Two years of demonstrated progressive leadership experience • Required RN licensure/registration appropriate to the state of work location: Illinois RN license; Missouri RN issued by a compact state or Missouri RN license; Oklahoma RN issued by a compact state or Oklahoma RN license; Wisconsin RN issued by a compact state or Wisconsin RN license • Frequent lifting/carrying and pushing/pulling objects weighing 0–25 lbs • Frequent sitting, standing, walking, reaching, repetitive foot/leg and hand/arm movements, vision/depth perception, hearing and speech, and keyboard use/data entry • Occasional bending, stooping, kneeling, squatting, twisting, gripping, and lifting/carrying or pushing/pulling objects weighing 25–50 lbs • Rare climbing

🏖️ Vorteile

• One week of paid parental leave for eligible team members for newborns or newly adopted children, pro-rated based on FTE • Flexible Payment Options through DailyPay, providing eligible hourly team members instant access to earned, unpaid base pay (fees may apply) • Upfront tuition coverage through FlexPath Funded for eligible team members • Comprehensive benefits package