Manager, Utilization Review

Health Business Solutions LLC; Cebu City; On-site; PHP 900,000 - 1,300,000; Full time

Job summary

Health Business Solutions LLC in Cebu City is seeking a Manager, Utilization Review to lead a team of Utilization Review Nurses and oversee daily UR operations. The role focuses on care coordination, cost management, and maintaining high-quality patient care standards.

You will drive performance through staff development, quality improvement initiatives, and collaboration with the healthcare team to optimize outcomes. Strong leadership and regulatory knowledge are essential.

Qualifications

• Current RN license with valid registration.
• BSN required; MSN preferred for leadership in Utilization Review.
• Experience in case management or care coordination with at least 2 years in a leadership role.
• Strong clinical assessment and critical thinking skills.
• Excellent communication and interpersonal skills.
• Knowledge of healthcare regulations and quality improvement methodologies.

Responsibilities

• Lead and mentor a team of Utilization Review Nurses.
• Oversee development and implementation of individualized care plans.
• Collaborate with healthcare professionals to ensure coordinated patient care.
• Monitor care plan effectiveness and resource utilization.
• Drive quality improvement initiatives and regulatory compliance.
• Manage department budget and optimize resource allocation.
• Provide ongoing staff education on best practices and regulations.
• Serve as patient advocate and participate in complex case reviews.
• Ensure accurate documentation in patient records per regulatory standards.

Skills

Leadership

Team Management

Care Coordination

Budget Management

Staff Development

Patient Advocacy

Regulatory Knowledge

Communication

EHR Proficiency

Data Analysis

Education

BSN

RN license

MSN (preferred)

Tools

EHR software

Healthcare software

Job description

The Manager, Utilization Review is responsible for overseeing the daily operations of the Utilization Review for one of our clients and leading a team of Utilization Review Nurses. This role involves ensuring efficient care coordination, managing healthcare costs, and maintaining high-quality patient care standards. The Manager, Utilization Review will collaborate with various healthcare professionals to improve patient outcomes and streamline care processes.

Key Responsibilities

• Leadership and Team Management:
  • Supervise and mentor a team of Utilization Review Nurses, providing guidance and support to ensure excellent performance.
  • Foster a collaborative and cohesive work environment within the department.
  • Conduct regular staff meetings, performance evaluations, and staff development activities.
• Care Coordination and Oversight:
  • Oversee the development and implementation of individualized care plans for patients.
  • Collaborate with the healthcare team to ensure coordinated and efficient patient care across different healthcare settings.
  • Monitor and assess the appropriateness of care plans and resource utilization.
• Quality Improvement:
  • Implement and monitor quality improvement initiatives to enhance patient outcomes and compliance with healthcare regulations.
  • Analyze data and metrics to identify areas for improvement in care coordination processes.
• Budget Management:
  • Manage the department's budget and resource allocation efficiently while maintaining high-quality patient care.
  • Collaborate with finance and administrative teams to optimize resource utilization.
• Staff Development:
  • Provide ongoing training and education to Utilization Review Nurses to keep them updated on best practices and regulatory changes.
  • Encourage professional growth and development within the department.
• Patient Advocacy:
  • Serve as a patient advocate, ensuring that patients' needs and preferences are addressed throughout their healthcare journey.
  • Participate in complex case reviews and offer guidance on challenging patient cases.
• Documentation and Compliance:
  • Ensure accurate and timely documentation of patient records, care plans, and progress notes in accordance with regulatory standards.

Qualifications

• Current RN (Registered Nurse) license. PHRN or USRN, Compact or Multi-State License strongly preferred.
• Bachelor's degree in Nursing (BSN) required; Masters (MSN) preferred.
• Previous experience in case management or care coordination, with at least 2 years in a leadership role.
• Strong clinical assessment and critical thinking skills.
• Excellent communication and interpersonal skills.
• Knowledge of healthcare regulations, insurance processes, and quality improvement methodologies.
• Proficiency in electronic health records (EHR) and healthcare software.
• Dedication to patient-centered care and a commitment to ethical practice.

If you are an experienced and visionary nurse leader who is passionate about improving patient care and outcomes, we invite you to apply for the Utilization Review Nurse Manager position. Join our team and lead the way in optimizing patient care. Apply today!