Manager of Utilization Review

Leadership Bellevue, Washington


Description

Overlake Medical Clinics have a great opportunity for a Manager of Utilization.  The Manager of Utilization Management is responsible for the daily operations of utilization review (UR), and utilization management (UM). The department assures continuity and coordination of care for patients before, during and after hospitalization, easing the transition for patients and families into and out of the hospital.  The department contributes to the realization of financial, utilization, and quality goals for targeted populations and that payer conditions are met. The Manager assumes 24-hour accountability and responsibility for area(s) assigned.  This individual is responsible for overall quality of service and for planning, developing, organizing, integrating, and managing programs, staff, and budget in support of the organizational goals and commitments.

 

Job Responsibilities:

Build effective working relationships throughout the organization with managers, staff, physicians, community partners/providers and payers and ancillary services.

Participate in development of the department budget and manage expenses and productivity to established targets.

Continually assess and improve care and services provided to meet or exceed the needs and expectations of customers.  Foster continuous quality improvement by leading teams in use of quality management tools and processes.

Utilization Review & Care Management

Collaborates closely with, and functions in support of, all attending physicians to maximize efficiency and effectiveness of patient care.

Covers interpreter services duties as needed for absences.

Promote effective -Utilization Management services by integrating professional, technical, fiscal and regulatory trends.  Evaluate best practice and community standards.

Maintain current knowledge or regulatory issues and practices related to area of expertise and leads change when needed to ensure compliance.

Exhibit behaviors that support the organization’s Service Standards and Cultural Beliefs.

Minimum Qualifications:

Education:  Bachelor’s in Nursing -required.  Master’s degree in nursing preferred.

Professional Licensure/Certification/Registration:  Current Washington RN - license required.  Certified Case Manager (CCM), Accredited Case Manager (ACM) certification desired

Experience:  Minimum of -five years’ experience in Care Management/Utilization Management services required.  Prior managerial experience preferred.

Working Conditions:  Work is performed in a well-lit, climate controlled office environment.  Exposure to a variety of noise levels, such as phones, equipment and conversations.  Potential exposure to body fluids, contaminants, and chemicals.

Physical Requirements: Have mobility that enables person access to patient care areas.  Able to effectively speak and hear for accurate communication on the phone and during face-to-face conversation.  Able to use computer keyboard.  Vision and hearing corrected to within normal limits.