Manager, Central Utilization Review- Full Time, Days, 8 AM - 4 PM, Morristown NJ

We need to output HTML fragment with sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. Need to parse job description. We need to extract sections: The posting includes many responsibilities, qualifications, etc. There's no explicit headings in the text; we need to infer sections. We need to produce

for each section heading. Use

• for lists,

  for prose. We must not repeat job title as heading. No Job ID etc. We must remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, application instructions. So we should cut out the EEO statement at end, the "About Us" maybe considered boilerplate? The instruction says remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. "About Us" might be considered not boilerplate? It's descriptive about the organization; maybe keep as part of "About the role"? But "About Us" is about the company, not role. Could be considered not needed. The instruction: "Prefer a few substantive sections over many thin ones." We can include sections like About the role (summary), Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to see if posting includes Pay and Schedule. It mentions "Note: In Compliance with the NJ Pay Transparency Act ... all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits." But actual pay range not given in the text. It says "Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer." No explicit pay range. So we should NOT include Pay section because no specific pay. Schedule also not mentioned. Benefits: there is a "Summary Atlantic Health offers a competitive and comprehensive Total Rewards package..." with list of benefits. So we can include Benefits section. Qualifications: includes Education, Experience, Licenses, Certifications. So we can have Qualifications section. Skills: maybe we can extract skills from responsibilities: leadership, communication, analytical, etc. But we need to see if there is explicit skills list. Not really. Could omit Skills if no specific content. Responsibilities: many bullet-like sentences. We'll create a

  • list. Requirements: maybe similar to Qualifications? The posting has "Qualifications Education ... Experience ... Required Licenses, Certifications..." So we can treat that as Qualifications. Requirements maybe not separate. Could combine. But we need to follow instruction: include a section ONLY when the posting has real, specific content for it. So we need to decide which sections have content. Let's extract: - About the role: maybe a brief summary: "Lead AHS clinical denial prevention and management initiatives to support appropriate level of care." That's the first sentence. Could be considered role summary. We'll put that as About the role. - Responsibilities: all the duties listed after that first sentence up to "Supervisory Responsibilities". We'll list them. - Supervisory Responsibilities: "The UR Nurses and Insurance specialist will report to this Central UR Manager". That's a supervisory responsibility. Could be part of Responsibilities or separate. We'll include as a bullet under Responsibilities. - Qualifications: Education, Experience, Licenses, Certifications. - Benefits: the Total Rewards package list. - Pay: not specific, so omit. - Schedule: not mentioned, omit. - Skills: not explicit list; maybe we can infer but better to omit. Thus sections: About the role, Responsibilities, Qualifications, Benefits. We need to ensure we preserve all substantive information; not invent or summarize away detail. So we need to include all responsibilities sentences as list items, not summarizing. We need to be careful not to include duplicated lines. The text has some repeated phrases? We'll deduplicate. Let's extract responsibilities sentences: Starting after first sentence: "Lead AHS clinical denial prevention and management initiatives to support appropriate level of care." That's actually the role summary; we might treat as About the role. Then: "Works closely with AHS revenue cycle leaders to complete current state assessment, evaluate, and implement leading practices for system standards and/or local market programs needed." "Evaluates clinical denials and appeals data, documentation, and workflows to identify and address process and performance gaps." "Lead successful denials prevention and performance improvement for AHS hospitals." "Monitors and manages AHS hospital performance to targets and leads corrective action plans needed to achieve organizational targets." "Collaborates with Executive Director of Case Management to address barriers and gaps in utilization review and authorization confirmation services." "Provides hospitals with performance data analytics to make decisions and drive improvement." "Works with hospital and market leaders to identify when improvement plan is needed and follows up to ensure successful execution." "Work with Managed Care Contracting to identify and address payer and Independent Review Organization (IRO) issues." "Collects and collates data from hospitals on payer issues and IRO results." "Provides AHS managed care leadership team with data to address issues with payers including avoidable days, contract violations, and process issues." "Provides input to contract language to support AHS case management service needs." "Participates with AHS Appeals with Physician Advisor in identifying and addressing trends with payor medical directors." "Provide oversight for appeals assigned to the Physician Advisor (PA) and potential account downgrades." "Supports the development and implementation of clinical appeals workflow to incorporate AHS Appeals PA review prior to any account downgrade." "Works with Conifer and Tenet Appeals PA to identify opportunities for improvement including documentation and process." "Utilizes findings for process improvement and hospital PA and case management education." "Identifies trends to address with managed care contracting and plan medical directors." "Uses tools to address performance barriers." "Develops and implements best practices to achieve organizational goals through effectively leading and managing change in a matrix environment." "Oversees the implementation of action plans and monitors progress toward goals assisting with addressing barriers and challenges and adjusting as needed in a supportive, synergistic manner." "Collaborates with medical and nursing leadership, as well as case management members to develop and implement methods to optimize use of hospital and post-acute services." "Manages multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance." "Provides analysis and education regarding regulatory and clinical changes impacting inpatient and post-acute care processes and reimbursement." "Provides education and tools for educating physicians and staff regarding programs and processes." "Works in alignment with hospital and revenue cycle leadership teams and consistently demonstrates ability to: Conduct financial analysis, develop business plans and secure approval for programs. Develop strategies to manage and prevent disputes and improve revenue cycle processes. Build trusting relationships with hospital and revenue leaders to successfully implement new programs. Build collaborative partnerships and lead cross functional teams to execute on plans and proposals. Identify process inefficiencies via root cause analysis and design workflow to address opportunities identified. Develop and implement action plans managing follow up to achieve outcomes. Implement targeted process changes including ongoing metric monitoring and management to achieve goals and drive improvement" Then "Supervisory Responsibilities The UR Nurses and Insurance specialist will report to this Central UR Manager" We could treat that as a bullet. Now Qualifications: "Education Graduate of an accredited school of nursing. Advanced degree in Business, Nursing and/or Health Care Administration required." "Experience Leadership experience care and management of acute hospitalized patients. Experience in acute care case management, Case management training from a professional Case Management organization, preferred." "Required Licenses, Certifications and/or Registrations Certificates ACMA or CCM preferred Licenses Current state license as a Registered Nurse" We need to preserve all. Benefits: list from "Team Member Benefits Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)Life & AD&D Insurance.Short-Term and Long-Term Disability (with options to supplement)403(b) Retirement Plan: Employer match, additional non-elective contributionPTO & Paid Sick LeaveTuition Assistance, Advancement & Academic AdvisingParental, Adoption, Surrogacy LeaveBackup and On-Site ChildcareWell-Being RewardsEmployee Assistance Program (EAP)Fertility Benefits, Healthy Pregnancy ProgramFlexible Spending & Commuter AccountsPet, Home & Auto, Identity Theft and Legal Insurance" We need to split into list items. Now we need to output HTML fragment with sections. We'll do:

    About the role

    Lead AHS clinical denial prevention and management initiatives to support appropriate level of care.

    Responsibilities

    • Works closely with AHS revenue cycle leaders to complete current state assessment, evaluate, and implement leading practices for system standards and/or local market programs needed.
    • Evaluates clinical denials and appeals data, documentation, and workflows to identify and address process and performance gaps.
    • Lead successful denials prevention and performance improvement for AHS hospitals.
    • Monitors and manages AHS hospital performance to targets and leads corrective action plans needed to achieve organizational targets.
    • Collaborates with Executive Director of Case Management to address barriers and gaps in utilization review and authorization confirmation services.
    • Provides hospitals with performance data analytics to make decisions and drive improvement.
    • Works with hospital and market leaders to identify when improvement plan is needed and follows up to ensure successful execution.
    • Work with Managed Care Contracting to identify and address payer and Independent Review Organization (IRO) issues.
    • Collects and collates data from hospitals on payer issues and IRO results.
    • Provides AHS managed care leadership team with data to address issues with payers including avoidable days, contract violations, and process issues.
    • Provides input to contract language to support AHS case management service needs.
    • Participates with AHS Appeals with Physician Advisor in identifying and addressing trends with payor medical directors.
    • Provide oversight for appeals assigned to the Physician Advisor (PA) and potential account downgrades.
    • Supports the development and implementation of clinical appeals workflow to incorporate AHS Appeals PA review prior to any account downgrade.
    • Works with Conifer and Tenet Appeals PA to identify opportunities for improvement including documentation and process.
    • Utilizes findings for process improvement and hospital PA and case management education.
    • Identifies trends to address with managed care contracting and plan medical directors.
    • Uses tools to address performance barriers.
    • Develops and implements best practices to achieve organizational goals through effectively leading and managing change in a matrix environment.
    • Oversees the implementation of action plans and monitors progress toward goals assisting with addressing barriers and challenges and adjusting as needed in a supportive, synergistic manner.
    • Collaborates with medical and nursing leadership, as well as case management members to develop and implement methods to optimize use of hospital and post-acute services.
    • Manages multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance.
    • Provides analysis and education regarding regulatory and clinical changes impacting inpatient and post-acute care processes and reimbursement.
    • Provides education and tools for educating physicians and staff regarding programs and processes.
    • Works in alignment with hospital and revenue cycle leadership teams and consistently demonstrates ability to: Conduct financial analysis, develop business plans and secure approval for programs. Develop strategies to manage and prevent disputes and improve revenue cycle processes. Build trusting relationships with hospital and revenue leaders to successfully implement new programs. Build collaborative partnerships and lead cross functional teams to execute on plans and proposals. Identify process inefficiencies via root cause analysis and design workflow to address opportunities identified. Develop and implement action plans managing follow up to achieve outcomes. Implement targeted process changes including ongoing metric monitoring and management to achieve goals and drive improvement.
    • The UR Nurses