Manager, Registered Nurse – Utilization Management

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🌽 Illinois, Oklahoma, +2 weitere Bundesländer – Remote

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

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SSM Health

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10.000+ Mitarbeiter

🛡️ Versicherung

💼 Beratung

📦 Logistik

💰 Debt Financing im 2019-11

Insurance • Consulting • Logistics

SSM Health ist ein katholisches, gemeinnütziges Gesundheitssystem, das Gemeinden im Mittleren Westen betreut. Es ist eines der größten katholischen Gesundheitssysteme in den Vereinigten Staaten und betreibt 23 Krankenhäuser sowie über 650 Arztpraxen, zusätzlich zu anderen ambulanten und virtuellen Gesundheitsdiensten in Illinois, Missouri, Oklahoma und Wisconsin. SSM Health widmet sich der Bereitstellung von qualitativ hochwertiger Versorgung durch ein umfassendes, integriertes Gesundheitsversorgungssystem. Die Organisation schätzt Vielfalt, Inklusion und das berufliche Wachstum ihrer 40. 000 Teammitglieder. SSM Health verpflichtet sich zu außergewöhnlicher Patientenversorgung und zeigt eine reiche Tradition des Dienstes seit über 150 Jahren.

Beschreibung

• Lead the team delivering high-quality, cost-effective patient care • Oversee system-wide day-to-day Utilization Management activities and services • Manage care coordination, utilization review, and regulatory compliance initiatives • Oversee 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; 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 quality improvement activities and company and department goals • Recruit, engage, develop, lead, and manage assigned staff • Analyze program and staff effectiveness • Perform other duties as assigned

🎯 Anforderungen

• Bachelor's degree in nursing • Two years' acute nursing registered nurse experience • Five years' utilization management experience • Two years' demonstrated progressive leadership experience • 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 • Ability to promote continuous improvement and adapt to evolving priorities • Ability to foster accountability, collaboration, adaptability, and engagement • Ability to partner with staff, physicians, and operational leaders • Required RN licensure for the applicable work location: Illinois RN issued by IDFPR; Missouri RN issued by a compact state or Missouri Division of Professional Registration; Oklahoma RN issued by a compact state or Oklahoma Board of Nursing; Wisconsin RN issued by Wisconsin Department of Safety and Professional Services • Ability to perform stated physical requirements, including frequent lifting/carrying and pushing/pulling of 0–25 lbs, occasional 25–50 lbs, frequent keyboard use, and rare climbing

🏖️ Vorteile

• Paid parental leave: one week 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 before payday (fees may apply) • Upfront tuition coverage through FlexPath Funded for eligible team members • Comprehensive benefits package