Utilization Management Lead-Utilization Review Full Time Days

Placement within the salary range is dependent on relevant work experience and internal equity. For positions represented by a labor union, placement is guided by the rules outlined in the collective bargaining agreement.

Pay

$40.50 - $64.80 hourly

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year ($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

For more details, visit jobs.nm.org/benefits.

About the role

The Utilization Management Lead reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities

• Collaborates with the director of care coordination to oversee the Utilization Review and Management process in accordance with NM UM Plan and operations of the UR team.
• Serves in a lead role by utilizing communication skills to build trusting interdisciplinary relationships; engaging in conflict management, coaching, mentoring, and staff development; fosters an environment for shared decision making.
• Collaborates with the director of care coordination to provide the utilization review team with an environment that supports their professional practice, health and well-being.
• Serves as the Utilization Management expert and collaborates with the director of care coordination for the implementation of evidence-based practice.
• Clearly identifies the internal and external customer(s) for their unit or service area and their respective requirements/expectations.
• Actively seeks methods of concurrent and retrospective feedback from customers, listens to customer feedback and implements solutions and/or interventions as appropriate.
• Continually examines ways to improve business relationships with customers, suppliers, and the community.
• Translates organizational vision into a unit or service area vision that engages team members in contributing to and achieving that vision.
• Provides feedback to improve employee performance and engagement.
• Seeks new ideas from a wide range of sources; encourages others to share knowledge and best practices.
• Maintains active membership in Professional Organization and shares current, relevant information.

Qualifications

Required:

• Graduate of an accredited school of nursing with a BSN
• Minimum of three years of case management experience in an acute care setting or health care environment

Preferred:

• ACM certification
• Masters Degree