RN Manager-Utilization Review
: Job Details :

Details * Department: Utilization Management * Schedule: Monday-Friday, 8:00AM-4:30PM. May involve occasional evening and weekend shifts. May have an on-call rotation for weekends or holidays, responsible for addressing urgent utilization management cases that arise during those times. * Hospital: Ascension St. Agnes * Location: Baltimore, MD * Salary: $38.49-$63.51 Actual compensation offered will vary based on factors including applicable licenses, certifications, education, experience, location, qualifications and comparison with associates in similar roles Registered Nurse, Certified Case Manager (CCM, ACM, URAC) preferred or willing to obtain within 1 year. Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community * Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics. Responsibilities Manage effective utilization review processes, including management of patient statusing processes and monitoring of medical necessity review functions for assigned sites. * Collaborate with the director to develop and implement quality review programs and key performance indicators for all utilization review activities. * Interact with medical, nursing, and executive leadership to facilitate quality based, cost effective patient statusing in the most appropriate setting, in compliance with regulatory and revenue cycle requirements. * Oversee day-to-day operations of the department and assists with the budgeting process. * Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Conduct hiring, training, directing, development and evaluation of staff Requirements Licensure / Certification / Registration: * Registered Nurse obtained prior to hire date or job transfer date required. Education: * Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. Work Experience: * Two years of related experience is required. Additional Preferences * 5 years Utilization Management experience, 3 years management or supervisory experience in a healthcare or insurance setting. * Strong communication and interpersonal skills for managing teams, dealing with healthcare providers, and communicating effectively with stakeholders. * Excellent analytical skills to assess the necessity of treatments, identify areas for improvement, and implement process optimizations. Why Join Our Team Ascension Saint Agnes in Baltimore, Maryland operates a full-service, 254-bed teaching hospital, the Ascension Saint Agnes Medical Group, Ascension Saint Agnes Imaging Center and Ascension Saint Agnes Foundation. As an associate, you will be a part of a team that is committed to providing a place of respect and inclusion for all associates, as well as a rich learning environment with countless opportunities for career growth and professional development. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you. Equal Employment Opportunity Employer Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster. As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension. Pay Non-Discrimination Notice Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.