Nurse Utilization & Care Management Leader

Community LIFE; Pittsburgh (Allegheny County); On-site; USD 83,000 - 113,000; Part time

Benefits offered by this job

Medical, Dental and Vision insurance

Life and Disability insurance

5 weeks Paid Vacation

Paid Holidays

403(b) retirement plan

Tuition Reimbursement

Mileage Reimbursement

Employee Appreciation events

Job summary

A healthcare organization in the United States seeks a Utilization Review Manager to oversee utilization management functions. This role involves developing policies, maintaining care protocols, and ensuring quality care for frail elders. Candidates should have a BSN, licenses in Pennsylvania, and at least 10 years of relevant experience. Community LIFE offers a competitive salary and benefits including medical, dental, and generous vacation time.

Qualifications

• 10+ years in managed care, particularly in utilization management.
• 5+ years in healthcare administration, medical, or case management.
• Experience with long-term care clients or frail elderly.

Responsibilities

• Direct and manage utilization management functions.
• Establish authorization and utilization management protocols.
• Serve as a liaison with hospitals and care agencies.

Skills

Data analysis

Development of clinical protocols

Strategic operational improvement

Care and disease management programs

Communication skills

Interpersonal skills

Detailed-oriented

Clinical assessment skills

Education

Bachelor's degree in nursing (BSN)

Master's degree in nursing (MSN)

Tools

Excel

Word

PowerPoint

Job description

A healthcare organization in the United States seeks a Utilization Review Manager to oversee utilization management functions. This role involves developing policies, maintaining care protocols, and ensuring quality care for frail elders. Candidates should have a BSN, licenses in Pennsylvania, and at least 10 years of relevant experience. Community LIFE offers a competitive salary and benefits including medical, dental, and generous vacation time.