Utilization Management Manager

100 LCMC Health; United States; On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Equal opportunity employer

Community-focused culture

Employee recognition programs

Job summary

LCMC Health is seeking an RN Manager of Care Management to lead the Case/Care Management department, ensuring quality care, consistency, and ongoing improvement. The role prioritizes utilization review, case management, and coordinating duties of direct reports.

You will supervise staff, align policies with regulatory standards, and collaborate with other departments to resolve claims while maintaining departmental calendars and reviewing denials and appeals.

Qualifications

• Minimum 3 years in case management or management.
• Supervisory experience preferred.

Responsibilities

• Oversee day-to-day administration of the Care Management Department to ensure quality care and continuous improvement.
• Supervise staff responsible for care management and assist in orientation and performance reviews.
• Review and revise departmental policies and procedures.
• Monitor HIPAA compliance and regulatory standards (TJC, CMS).
• Represent department on hospital committees and coordinate with other departments.
• Coordinate and evaluate case management processes and resolve outstanding claims.
• Monitor utilization review and assign reviews to case managers.
• Assist with denials and appeals and monitor case work queues.
• Maintain department calendar and vacation/time-off requests.
• Serve as primary contact for revenue cycle staff and respond to referred cases.

Skills

Case management

Leadership

Education

RN license (Louisiana)

Certified Case Manager (preferred)

Job description

Your job is more than a job The RN Manager of Care Management assumes responsibility for general administration of the Case/Care Management department on a day-to-day basis to ensure quality care, consistency and continuous departmental improvement. Manages day to day tasks related to utilization review, case management and the coordination of responsibilities of direct reports. Participates in the implementation, coordination of approved mechanisms to identify problems/opportunities to improve and foster resolutions to maximize the quality of care rendered to patients.

GENERAL DUTIES

• Assumes responsibility for general administration of the Care Management Department on a day-to-day basis to ensure quality care, consistency and continuous departmental improvement: Assists in supervision of staff responsible for care management.
• Assists with employee orientation and performance appraisals.
• Assists in the review and revision of departmental policies and procedures.
• Monitors departmental compliance with HIPPAA.
• Represents the department at hospital and medical staff committees as assigned.
• Assists in the coordination and evaluation of case management process: Works and collaborates with other departments to resolve outstanding claims.
• Monitors utilization review process to ensure effectiveness of the program.
• Assigns reviews to case managers.
• Assists with denials and appeals.
• Monitors, maintains department calendar and vacation/time off requests.
• Monitors case management work queues.
• Assists with ensuring compliance with regulatory standards: Assists in facilitating compliance with regulatory standards (TJC, CMS).
• Keeps abreast of regulatory agency standards and assures that the hospital is in compliance with current regulations concerning case management.
• Serves as the primary contact for staff of concerned/revenue cycle department: Serves as the entry point for all cases referred by any department, work queues and other venues for case referral.
• Conducts research and responds on all referred cases.

EXPERIENCE QUALIFICATIONS

• 3 years case management/management required. Supervisory experience preferred.

LICENSES AND CERTIFICATIONS

• Registered Nursing License (RN) - Louisiana State Board of Nursing required. Certified Case Manager preferred.

WORK SHIFT

Days (United States of America)

LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary.

Your extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits‑all, think one‑of‑a‑kind care.
• See opportunities, not problems – it’s all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do
• You are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Simple things make the difference.

About LCMC Health One‑of‑a‑kind care comes from one‑of‑a‑kind people. At LCMC Health, our people are the magic ingredient that makes our care so extra‑extraordinary. We are compassionate, driven, and dedicated to bringing a little something extra to healthcare and to the people of New Orleans and beyond. If you’re the kind of person who believes that our community deserves the best and that healthcare needs a little more heart, we want you to be a part of our family. From medical roles to administrative positions, every person on our team plays a part in our mission: to provide health, care, and education beyond extraordinary. Let’s make every day extraordinary, together.