RN Utilization Review Manager - Lead Quality-Care Outcomes

Capital Health (US); United States; On-site; USD 98,000 - 128,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage & In-House

Dental Plan

Vision Plan

FSA

Job summary

Capital Health is a leader in patient care with a dedicated utilization review department. This role leads a team, conducts reviews, and partners with payers to ensure timely, appropriate care. A BSN is required and leadership experience in UR is preferred.

The position is not remote and offers comprehensive benefits with a strong focus on patient outcomes. The successful candidate will oversee daily UR functions, drive performance improvement, and mentor staff, ensuring adherence to provider

Qualifications

• BSN required; ADN with experience may be considered in lieu of BSN.
• 4 years of nursing experience including case management in utilization review, discharge planning, outcomes management or care coordination.
• Strong leadership and project management capabilities.
• Excellent interpersonal, communication and negotiation skills.

Responsibilities

• Performs utilization review to promote quality, cost-effective outcomes.
• Leads and mentors utilization review staff; assigns and reviews work.
• Coordinates with payer communications and ensures compliance with policies.
• Participates in performance improvement and regulatory compliance activities.

Skills

Interpersonal skills

Communication

Negotiation

Leadership

Team building

Analytical skills

Education

BSN

ADN with experience considered

Tools

DNV standards

Job description

Capital Health is a leader in patient care with a dedicated utilization review department. This role leads a team, conducts reviews, and partners with payers to ensure timely, appropriate care. A BSN is required and leadership experience in UR is preferred.

The position is not remote and offers comprehensive benefits with a strong focus on patient outcomes. The successful candidate will oversee daily UR functions, drive performance improvement, and mentor staff, ensuring adherence to provider