Head of Utilization Management & Care Optimization

UNM Hospital; Albuquerque (NM); On-site; USD 110,000 - 165,000; Full time

Job summary

UNM Health is seeking a leader to manage the Utilization Management program at UNM Hospital, overseeing day-to-day operations and ensuring compliant, efficient use of medical resources. You will lead reviews, staffing, training, and develop performance improvements across neonate to geriatric care.

Qualifications include a Master’s Degree, NM RN license, CPR certification, and 4+ years’ experience with InterQual/MCG criteria.

Qualifications

• Experience with InterQual and/or MCG criteria (4+ years)
• RN license in NM or via reciprocal agreement
• CPR for Healthcare/BLS Prov or Prof Rescuers within 30 days

Responsibilities

• Supervision: oversee department personnel, train and monitor work, manage staffing to fit needs
• Leadership: identify problems, plan improvements, hire/train/evaluate staff
• Budget: develop and monitor department operating budget
• Oversight: ensure utilization review from initial to concurrent review and denials
• Reimbursement: seek optimal reimbursement from government payers with proper authorization
• Quality: conduct quality reviews of utilization management processes
• Process improvement: develop and implement improvement action plans
• Collaboration: work with physicians, departments, patients, and payers to complete functions
• Data: collect and present data for units and committees
• Training: develop staff skills and conduct training
• Development: stay informed on regulations and build payer relationships
• Patient safety: follow safety policies and report issues

Skills

InterQual/MCG criteria

Education

Master's Degree

Related Discipline (BSN required if not MSN)

MSN or DNP

Job description

UNM Health is seeking a leader to manage the Utilization Management program at UNM Hospital, overseeing day-to-day operations and ensuring compliant, efficient use of medical resources. You will lead reviews, staffing, training, and develop performance improvements across neonate to geriatric care.

Qualifications include a Master’s Degree, NM RN license, CPR certification, and 4+ years’ experience with InterQual/MCG criteria.