Manager Utilization Management

Manager Utilization Management

  Not Disclosed

  Philadelphia, PA

  4.0 Months

  Not Disclosed

  Not Disclosed

  Pharmaceutical

Job Description

Manager Utilization Management

Job Summary:

Under the direction of the Senior Director, Case Management, the Manager Utilization Review (UR) has responsibility for oversight of the development, implementation and performance management of the Utilization Review and Denials Prevention program across all the client acute hospitals.
The Manager Utilization Management is responsible for utilization review and authorization management services, to promote appropriate level of care, length of stay, and prevent payer denials.
Manages daily operations, which include supervising the staff performing utilization management and denial prevention activities. This role functions as the internal resource on issues related to utilization review and management. The manager is responsible for carrying out assignments in a manner to assure success in financial management, human resources management, leadership, quality and operational management objectives.

The manager consistently demonstrates the ICARE values of the client and serves as a role model to other employees.

Skills

Excellent communication skills and demonstrated organizational skills.

Knowledge of payor contracts and regulatory requirements.

Ability to work effectively with all departments and all levels of the client professionals.

Ability to work independently or within a team structure.

Must be very organized and able to work independently.

Ability to establish priorities among multiple needs, meet deadlines and maintain standards of productivity.

Knowledge of managed care admission process (i.e. verification of benefits, admissions notification).

Ability to effectively negotiate with internal and external providers of patient care services.

Sound problem solving and analytical skills.

Excellent customer service orientation and strong interpersonal skills.

Computer skills and a working knowledge of Word, Excel and PowerPoint.

Education

Required Licenses, Certifications, Registrations

Registered Nursing License in the Commonwealth of Pennsylvania

Required Education: Bachelor’s degree in Business, Nursing and/or Health Care Administration

Required Experience:

• Registered Nurse with a minimum of three (3) years’ experience as clinical nurse in an acute care setting.

• A minimum of five (5) years of hospital or health care leadership

Preferred Education, Experience & Cert/Lic

Preferred Education: MSN, MBA, or MHA

Preferred Experience:

• Prior experience as a Case Manager or Utilization Reviewer.

• Case Management Leadership role.

Preferred Certifications: Accredited Case Manager (ACM) or Certified Case Manager (CCM)

level 3 - COVID Vaccine required
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.