Registered Nurse (RN) Manager - Utilization Review - Full-Time - Day

About the role

This leadership position manages the Utilization Management (UM) program, ensuring adherence to standards, regulations, and best practices to optimize patient care and program efficiency. The role involves overseeing all aspects of utilization review, patient care coordination, staff education, financial management, and regulatory compliance.

Responsibilities

• Lead and coordinate UM processes from admission to discharge, ensuring compliance with CMS and payor standards.
• Analyze utilization data, interpret reports, and make recommendations to improve outcomes and cost-effectiveness.
• Foster collaboration with physicians, hospital departments, and external stakeholders to enhance patient throughput and quality care.
• Manage staff performance, development, and engagement while promoting a positive environment and teamwork.
• Develop and update educational resources, facilitate staff training, and ensure professional competency.
• Monitor financial performance, assist in budget development, and implement cost-effective strategies.
• Ensure regulatory and contractual compliance, participating in committees and representing the program at professional meetings.

Qualifications & Skills

• Leadership experience in healthcare utilization management or related fields.
• Strong knowledge of CMS, Joint Commission standards, and payer regulations.
• Excellent analytical, communication, and collaboration skills.
• Ability to manage budgets, analyze data, and implement quality improvement initiatives.
• Commitment to staff development, customer satisfaction, and regulatory compliance.