Case Management and Utilization Review Manager

About the role

Sheridan Memorial Hospital is a top 13.6% ranked hospital recognized by the Centers for Medicare and Medicaid Services. We have over 850 dedicated employees and 100+ expert providers across 25 specialties, committed to providing exceptional, patient-centered care. Located in the picturesque Big Horn Mountain foothills of northern Wyoming, our hospital combines advanced technology with a collaborative, innovative culture. Join us to make a meaningful impact in patient care.

Responsibilities

• Oversight of EHR referrals and usage
• Utilization Review
• Care Coordination
• Discharge Planning
• Denials Management
• Case Management
• Support/replacement for Care Coordinator, Utilization Review Nurse, or Discharge Planner
• Production and management of agreed-upon metrics and reports
• Operational leadership of the Utilization Review Committee
• Operational leadership of regulatory requirements for discharge planning, readmission reduction, and quality metrics
• Updates the Utilization Review plan as required
• Oversees EHR referrals and usage
• Manages qualifications, competencies, staffing levels, workload, and productivity
• Maintains systems, processes, and education to improve customer satisfaction and hospital outcomes
• Applies CMS Conditions of Participation and Joint Commission regulations, updating the department accordingly
• Reviews medical management data for trends and opportunities for improvement
• Reviews current processes regularly to ensure maximum efficiency and effectiveness
• Assesses departmental data and success of plans, making adjustments as necessary
• Provides data for quality councils and other performance measures
• Collaborates with physicians in discharge planning and utilization review for continuous improvement
• Provides coaching and mentoring to staff
• Ensures compliance with safety policies and good housekeeping
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational needs and business goals
• Administers organizational policies and procedures
• Manages initial and ongoing training of new employees
• Promotes teamwork and commitment to customer satisfaction
• Ensures appropriate coverage of all areas of responsibility
• Writes and conducts annual performance appraisals
• Ensures high performance standards and achievement to meet organizational