Utilization Review Nurse Manager

Children's Mercy; Kansas City (MO); On-site; USD 70,000 - 90,000; Full time

Job summary

A children's health organization seeks a Utilization Review Nurse Manager to lead integrated inpatient teams and manage department functions effectively. Responsibilities include resource management, participation in performance improvement activities, and oversight of quality initiatives. Candidates should have a Bachelor's in nursing with significant experience in Utilization Review. This position requires onsite work at our Kansas City location.

Qualifications

• 3-5 years experience in Utilization Review.
• Licensed RN in MO or Kansas required.
• Must obtain American Case Management or Certified Case Manager within specified time.

Responsibilities

• Participates in department and organization performance improvement activities.
• Department management and program development.
• Assists the department Director with fiscal management and accountability.

Skills

Utilization Review

Leadership

Quality Improvement

Resource Management

Education

Bachelor's Degree in nursing

Master's Degree in nursing

Job description

Utilization Review Nurse Manager

Children's Mercy

The UR Manager will provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/appeals oversight. Participates in department and hospital performance improvement activities; Responsible for outcomes reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family centered care management and services.

Responsibilities

• Participates in department and organization performance improvement activities
• Department management and program development
• Assists the department Director with fiscal management and accountability

Qualifications

• Bachelor's Degree in nursing and 3-5 years experience in Utilization Review
• Master's Degree in nursing required within 4 years of hire, 1-2 years experience in Utilization Review
• One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire
• One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire
• RN Compact license for all states besides KS and MO
• Must obtain KS or MO Compact within 60 days of hire
• One of the following: American Case Management, Certified Case Manager required upon hire
• Employees must obtain American Case Management or equivalent within 730 days
• Employees must obtain Certified Case Manager or equivalent within 730 days
• Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire

Remote Work/Work from Home

This position is not eligible to work remotely, which means that the person hired will be required to work onsite at one of our Children’s Mercy locations and may not work from home.

Seniority level

Mid‑Senior level

Employment type

Full‑time

Job function

Administrative