8 Jobs
Ochsner Health is Hiring an Utilization Review Manager Near Lafayette, LA
- Required - Bachelors degree in nursing (BSN).
- Master's degree in social work (MSW).
- Required - 3 years of case management experience in an acute care setting or similar environment.
- Experience in compliance management systems (CMS) regulations, compliance and quality metrics.
- Experience managing denials and appeals of all payer cases in a timely and organized manner.
- Preferred - 1 year of management level experience.
- Experience in managed care, quality management, regulatory compliance, medical management, or other related MCO departments/functions.
- Required - Current registered nurse (RN) license in state of practice.
- *MSW accepted in lieu of registered nurse (RN) licensure.
- Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM).
- Proficiency in using computers, software, and web-based applications.
- Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
- Conflict resolution skills and ability to demonstrate good judgement in performing duties.
- Knowledge of business management principles including operations, finance, audit, authorizations, referrals, discharge planning, personnel, and resource management.
- Understanding of financial statements and ability to manage within a budget, analyze trends, and make recommendations.
- Must be able to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability)
- Leads respective teams with high motivation and responsibility for the welfare of the entire team making decisions based on good judgement rather than popularity.
- Promotes, supports, encourages, and fosters maximum communication across case management with the purpose of making one accessible and available to all team members ensuring that effective problem analysis is exercised across all levels of the organization.
- Conducts personal leadership self-development with the conscious intention to always become a better, more effective leader.
- Manages the implementation controls for all precertification, continued stay, authorization and billing processes as well as policies and procedures required for success under the direction of the case management leadership.
- Leads special and audit projects independently with the end goal of ensuring that the internal control environment is not compromised and the awareness of the process control culture is increasingly heightened.
- Determines appropriate staffing levels and the interviewing, hiring, performance review, and termination of employees within practice unit(s); maintains employee schedules to assure appropriate coverage.
- Develops departmental specific systems to assure an environment that emphasizes patient courtesy and responsive service delivery.
- Performs other related duties as required.
Job Summary
Full Time
Hospital
$98k-129k (estimate)
05/09/2024
07/07/2024
ochsner.org
MARRERO, LA
7,500 - 15,000
1942
KIM RADETICH
$3B - $5B
Hospital
Related Companies
The job skills required for Utilization Review Manager include Managed Care, Case Management, Billing, Leadership, Acute Care, Medical Management, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Manager. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Manager positions, which can be used as a reference in future career path planning. As an Utilization Review Manager, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Manager. You can explore the career advancement for an Utilization Review Manager below and select your interested title to get hiring information.
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