RN Utilization Management Lead – Acute Care

Summa Health; Cleveland (OH); On-site; USD 57,000 - 85,000; Full time

Benefits offered by this job

Retirement Savings Plan

Basic Life & AD&D insurance

Disability Insurance (Short/Long-Term)

Employee Assistance Program (EAP)

Education Assistance

Daily Pay

Job summary

Summa Health is seeking a leader for Utilization Management in acute care, focused on developing and supervising clinical workflows that align with CMS guidelines and payer contracts. You will oversee utilization decisions across the care continuum and collaborate with case management and physicians to optimize patient transitions.

The role requires nursing leadership experience in utilization management, with a strong emphasis on cost-effective care and high-quality outcomes for diverse patient

Qualifications

• ADN required; BSN preferred.
• CCNE- or ACEN-accredited nursing program.
• Current Ohio RN license.
• Three years of utilization management, discharge planning, managed care, or case/care management experience.

Responsibilities

• Develops and oversees utilization management.
• Leads interfaces with clinical staff across the continuum.
• Directly supervises Utilization Management RNs to ensure competency and efficiency.
• Collaborates with Manager to achieve quality outcomes as patients transition between settings.
• Ensures cost-effective utilization across the care continuum in line with CMS guidelines and payer contracts.

Skills

Utilization management

Discharge planning

Case management

Education

ADN required

BSN preferred

CCNE/ACEN accredited program

Job description

Summa Health is seeking a leader for Utilization Management in acute care, focused on developing and supervising clinical workflows that align with CMS guidelines and payer contracts. You will oversee utilization decisions across the care continuum and collaborate with case management and physicians to optimize patient transitions.

The role requires nursing leadership experience in utilization management, with a strong emphasis on cost-effective care and high-quality outcomes for diverse patient