Clinical Manager Utlization Review RN

Prolink; Saginaw (MI); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Retirement plan with employer match

Paid time off

Wellness programs

Tuition reimbursement

Job summary

Prolink’s confidential acute care hospital in Saginaw, MI is seeking a Clinical Manager, Utilization Management to lead the UM department. This leadership role oversees utilization review operations, staff supervision, and collaboration with Physician Advisors to ensure appropriate, compliant patient care for a 280-300 daily census.

The Clinical Manager reports to the Director of Revenue Cycle and handles daily UM operations, budget, and cross-functional collaboration with Coding, CDI, Case

Qualifications

• Bachelor's degree required and MI RN license.

Responsibilities

• Lead Utilization Management daily operations and staff supervision.
• Ensure CMS Conditions of Participation compliance and clinical review guidelines.
• Oversee department budget, payroll, staff evaluations, and corrective actions.
• Collaborate with Physician Advisors on medical necessity and level-of-care decisions.
• Coordinate with Revenue Cycle, Coding/CDI, Case Management, and Billing/Denials leadership.
• Chair the Utilization Committee and drive department strategy and performance metrics.
• Oversee onboarding and transition with outgoing team and Physician Advisor.

Skills

UM leadership

RN leadership

CMS/POC compliance

Interdepartmental collaboration

Education

Bachelor's Degree

RN License in MI

Tools

Epic

InterQual

MCG

Job description

A confidential acute care hospital in the Saginaw, MI area is hiring a Clinical Manager, Utilization Management to lead their UM department. This is a key leadership role overseeing utilization review operations, staff supervision, and physician advisor collaboration to ensure appropriate, compliant patient care across a 280-300 daily census.

Job Summary

The Clinical Manager, Utilization Management reports to the Director of Revenue Cycle and is responsible for the daily operations of the Utilization Management department, including staff supervision, compliance oversight, budget management, and cross-functional collaboration with Coding, Clinical Documentation Improvement, Case Management, and Billing/Denials teams. This leader also chairs the Utilization Committee and works directly with Physician Advisors on medical necessity and level-of-care decisions.

Responsibilities

• Manage and supervise Utilization Review RN staff, a UM Tech, and UM Admin support
• Ensure department compliance with CMS Conditions of Participation and clinical review guidelines
• Own department budget preparation, payroll oversight, staff performance evaluations, and corrective action
• Partner with Physician Advisors on medical necessity determinations and level-of-care decisions
• Collaborate with Revenue Cycle, Coding/CDI, Case Management, and Billing/Denials leadership
• Chair the Utilization Committee and drive department strategy, workflow, and performance metrics
• Complete hospital New Employee Orientation and department onboarding, working alongside the outgoing team and Physician Advisor to transition responsibilities

Qualifications

• Bachelor's Degree required
• Active Registered Nurse (RN) license in the State of Michigan required
• Experience in Utilization Management and/or Clinical Documentation Improvement required
• Minimum 3 years supervisory/management experience preferred
• Minimum 5 years of experience in an acute care patient setting preferred
• Experience with Epic, Interqual, and/or MCG preferred

Comprehensive benefits package including medical/dental/vision coverage, retirement plan with employer match, paid time off, wellness programs, and tuition reimbursement.