Utilization Review and Clinical Program Manager

Lakewood Health System; Staples (MN); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Generous PTO

Wellness Time Off

401K Match

Tuition assistance $2,000/yr

HSA contributions

Employer paid premiums for individual-

Job summary

Lakewood Health System in Minnesota is seeking a Utilization Review and Clinical Programs Manager (RN) to oversee medical necessity reviews, patient status, and length of stay, while coordinating trauma and stroke program designations. The role requires clinical leadership, collaboration with medical directors and care teams, and a focus on quality improvement.

The ideal candidate has RN licensure in Minnesota, acute care experience (including trauma), and strong analytical, organizational, and

Qualifications

• RN license (Minnesota) is required.
• Experience in utilization review and program coordination preferred.
• Familiarity with trauma and stroke designation standards is preferred.

Responsibilities

• Oversee utilization review activities to support medical necessity and denial prevention.
• Provide leadership for trauma and stroke programs and designation readiness.
• Monitor patient status, length of stay, and documentation opportunities; support payer reviews and appeals.
• Collaborate with nursing administration, medical directors, and interdisciplinary teams to improve clinical processes and ensure regulatory compliance.

Skills

Utilization review

Trauma program management

Stroke coordination

Quality improvement

Care management

Leadership

Regulatory knowledge

Education

RN license (Minnesota)

Tools

MCG criteria

Job description

About LakewoodLakewood Health System is a comprehensive rural healthcare system in central Minnesota. Leading the way in providing quality, personalized healthcare for a lifetime, Lakewood prides itself on remaining fiercely independent to prioritize its patients, staff, and communities in all decisions. Voted as one of Star Tribune’s Top Workplaces for the sixth year in a row, we do rural healthcare differently at LHS by providing a solid foundation of family practice providers with access to best-in-class specialty services, all right here at Lakewood. Across the spectrum of life, Lakewood Health System provides compassionate, quality care for the Brainerd Lakes region and beyond.About the DepartmentThe Nursing Administration department provides leadership and support for clinical operations, patient care quality, and regulatory compliance throughout Lakewood Health System. The department works collaboratively with providers, nursing teams, and interdisciplinary departments to promote safe, effective, and efficient patient care.Mission for PositionThe Utilization Review and Clinical Programs Manager is responsible for overseeing utilization review activities to support medical necessity, appropriate patient status, denial prevention, and effective utilization of healthcare resources. This position also provides leadership and coordination for Lakewood Health System's trauma and stroke programs, ensuring compliance with regulatory requirements and maintaining program designation readiness. The manager collaborates with Nursing Administration, medical directors, and interdisciplinary teams to strengthen clinical processes, improve quality outcomes, and support patient-centered care.Duties & ResponsibilitiesThe Utilization Review and Clinical Programs Manager conducts medical necessity reviews using MCG criteria, monitors patient status and length of stay, identifies documentation opportunities, and supports payer reviews, denial prevention, and appeals. This role also serves as the designated Trauma Program Manager and Stroke Coordinator, overseeing program compliance, performance improvement initiatives, required reporting, education, and designation readiness. Additional responsibilities include collaborating with medical directors, providers, nursing, care management, and other departments to improve clinical processes, support regulatory compliance, and promote effective resource utilization.Position TypeThis is a full-time, (1.0 FTE) position.Current, unrestricted Minnesota Registered Nurse (RN) license.Acute care nursing experience, including emergency and trauma care.Strong clinical judgment, organizational skills, and attention to detail.Excellent communication, documentation review, and interdisciplinary collaboration skills.Ability to analyze clinical data, identify opportunities for improvement, and maintain required role-specific competencies.Experience in utilization review, trauma program management, stroke coordination, care management, or quality improvement preferred.Familiarity with MCG criteria, Medicare and Critical Access Hospital requirements, and Minnesota Department of Health trauma and stroke designation standards preferred.Ideal CandidateThe ideal candidate is an experienced and detail-oriented registered nurse with strong clinical judgment, leadership abilities, and a passion for quality improvement. This individual is comfortable analyzing clinical information, navigating regulatory requirements, and collaborating with interdisciplinary teams. They are organized, proactive, and able to balance utilization review responsibilities with trauma and stroke program coordination while maintaining a commitment to patient safety and high-quality care.BenefitsLakewood Health System is growing and looking for great people to join our mission of providing personalized, quality healthcare for a lifetime. At Lakewood, our people are our most valued asset!Generous Planned Time Off & Wellness Time Off401K MatchAnnual tuition assistance of $2,000 per yearBest-in-region employer HSA contributionsEmployer paid premiums for individual-only healthcare coverage!With ample opportunities for growth within the system and support as you pursue your personal goals, it's safe to say that Lakewood Health System is a great place to launch or continue your career in healthcare!A new team member's starting wage reflects our compensation philosophy, taking into account experience, education, certifications and internal equity. Hourly pay is just one part of the comprehensive and rewarding compensation package we're proud to provide! Please be sure to include all applicable experience in your application.If you need an accommodation during the application process, please call 218-894-8524 or email [e-mail], but will the schedule work for you? Have questions on organizational culture, team fit or day-to-day experience?>>>Contact Sarah Baumgartner to discuss the possibilities further:Sarah Baumgartner, VP of NursingP: 218-894-8505E: [e-mail]:Job postings found on third-party websites may be outdated or no longer active. For the most accurate and up-to-date listing of career opportunities, and to apply directly, please visit our official website at www.lakewoodhealthsystem.com