RN Utilization Review Manager — Care Efficiency Leader

University of Minnesota School of Nursing; Billings (MT); Hybrid; USD 90,000 - 120,000; Full time

Job summary

The University of Minnesota School of Nursing seeks a Manager of Utilization Review to oversee the utilization review process, optimize resource use, and promote cost-effective, high-quality patient care across departments.

You will lead a team of Utilization Review Specialists, collaborate with medical staff and payers, analyze trends, ensure regulatory compliance, and drive quality improvement initiatives to improve outcomes and reduce unnecessary costs.

Qualifications

• Bachelor's degree in Nursing is required.
• Minimum of 5 years of clinical experience.
• Experience with healthcare information systems and software.
• Previous management or supervisory experience.

Responsibilities

• Oversee the Utilization Review process to ensure appropriate and cost-effective use of resources.
• Develop and implement utilization management strategies and protocols.
• Collaborate with medical staff and Case Managers to evaluate medical necessity and treatment plans.
• Lead and mentor a team of Utilization Review Specialists.
• Analyze utilization data and trends to identify efficiency improvements and cost reductions.
• Monitor provider performance and implement corrective action plans.
• Stay updated on regulations and technologies in utilization management and ensure compliance.
• Maintain thorough documentation of utilization activities and regulatory compliance.
• Collaborate with payers to ensure timely reimbursement and resolve issues.
• Participate in quality improvement initiatives with the Quality Management team.

Skills

Clinical experience

Healthcare IT systems

Team leadership

Utilization review knowledge

Education

Bachelor's degree in Nursing

Tools

Healthcare information systems

Job description

The University of Minnesota School of Nursing seeks a Manager of Utilization Review to oversee the utilization review process, optimize resource use, and promote cost-effective, high-quality patient care across departments.

You will lead a team of Utilization Review Specialists, collaborate with medical staff and payers, analyze trends, ensure regulatory compliance, and drive quality improvement initiatives to improve outcomes and reduce unnecessary costs.