Manager- Utilization Management

ECU Health; Greenville (NC); On-site; USD 92,206 - 134,397; Full time

Job summary

ECU Health in Greenville, North Carolina, is seeking a qualified candidate for a Utilization Management role. The position is responsible for overseeing the Utilization Management program, developing policies, and ensuring compliance with regulatory requirements. A bachelor's degree in Nursing and 3 to 4 years of related experience are required, with a master's degree preferred.

The successful candidate will develop and manage departmental budgets, and facilitate collaboration within the organization. The pay range is between $92,206.40 and $134,397.12 annually.

Qualifications

• Bachelor's degree in Nursing.
• 3 to 4 years of related experience required.
• Preferred: experience with clinical evidence-based tools.

Responsibilities

• Develops and administers ECU Health's Utilization Management approach.
• Establishes quality expectations and policies for UM services.
• Coordinates recruitment and development of departmental staff.
• Maintains compliance with regulatory bodies.
• Develops and manages departmental budgets.

Skills

Nursing

Program management

InterQual

MCG

Education

Bachelor's degree in Nursing

Master's degree

Job description

Position Summary

• Management accountability and decision‑making authority for determining and implementing the strategies, interventions and activities that will be effective and appropriate to further enable the capability of the UR processes.
• Accountable for ensuring performance of the program in accordance with goals and stewardship responsibilities.
• Communicates key management decisions and informs department leadership of issues affecting program and system performance effectiveness.
• Facilitates development of and adjustments to work plans, work processes, budgets, staffing levels, and other resources needed to deliver services that meet expectations of the program.
• Facilitates change to advance the organization and uses resources and operational practices to drive execution of plans.
• Ensures that policies, procedures and practices are operationalized to support safe, reliable care, regulatory compliance, and fosters a continuous learning culture.
• Accountable for a positive organizational culture in decision making and performance management to influence work attitudes and enhance job satisfaction.

Responsibilities

• Develops, directs, and administers the ECU Health approach to Utilization Management (UM) in conjunction with the Administrator of UM and Medical Director for UM.
• Establishes quality expectations and develops, plans, and implements policies and procedures to enhance services provided by the UM Services Department.
• Coordinates the screening, interviewing, selecting, development and evaluation of departmental staff.
• Develops and implements mechanisms to enhance collaboration with internal and external resources.
• Coordinates the Utilization Review process and maintains accountability for compliance with regulatory bodies and commercial contracts (Inpatient units across the health system as applicable).
• Develops and administers departmental budgets consistent with the goals and philosophies of the organization.
• Supports the use of clinical and management information technology and works in conjunction with key stakeholders and the information services function.

Minimum Requirements

Bachelor's degree in Nursing.

3 to 4 years of related experience is required.

Preferred Requirements

Master's degree is preferred.

Experience with clinical evidenced based tools; MCG and/or InterQual.

Pay Range

$92206.40 - $134397.12

Equal Employment Opportunity Statement

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.