Manager, Utilization Management RN

at  Providence

DESCRIPTION

The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Southern California Region.
The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and evaluation of hospital activities related to patient admission, transfers, and discharges in a variety of clinical settings. Accomplishes results through multiple experienced individual staff members who exercise latitude and independence in their assignments. Fosters team collaboration, sharing of workload and enhanced productivity.
This role provides direction for and leadership to a large team of Utilization Management RNs in the care of patients by facilitating allocation of resources related to a pre-determined set of criteria. This role acts as a facilitator between the UM RNs and the ministry Care Management departments. Ensures that there is regulatory compliance for appropriate services that are monitored in order to optimize patient outcomes and maximize optimum financial outcomes. In turn, advocates for full and adequate resource allocation, which is beneficial to the organization where patients receive care.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree in Nursing or other related area
• Upon hire: California Registered Nurse License
• 5 years Healthcare management experience related to acute care utilization management or appeals management.

PREFERRED QUALIFICATIONS:

• Master’s Degree in Nursing or other related area
• Coursework/Training: Case Management Certification
• 2 years minimum of two years direct patient care experience in an acute care setting is preferred. Other direct patient care experience may consider in lieu of acute care
• Previous experience working with denials and appeals in/for an acute care setting
• Previous experience working with a remote UR team
• Previous experience as a case manager in an acute care setting

Please refer the Job description for details