VCU Health System's Care Coordination Department is seeking a full time Manager, Utilization Management that will oversee and manage the day-to-day operations of the Utilization Management (UM) program for VCU Health System. Develop, evaluate, and monitor the UM program focused on medical appropriateness, regulatory compliance, and payer relations. Develop and implement strategic plans directly impacting cost containment, revenue enhancement, and improved patient outcomes. Ensure compliance with regulatory requirements and application of clinical decision support criteria for UM activities deemed by federal, state, and other regulatory and accreditation agencies.
Clinical decision-making in collaboration with physicians and daily prioritization of activities. The allocation of time spent in patient care and elsewhere is largely self-determined.
Master of Science in Nursing from an accredited School of Nursing
Licensed Registered Nurse in the State of Virginia or eligible
Minimum of five (5) year's clinical experience including three (3) years utilization management experience in a hospital, insurance company, or other applicable setting
Minimum of two (2) years progressive leadership experience as a lead or supervisor
Case Management Certification
Experience in hiring, training, and managing the performance of staff
Prior experience in a large, academic healthcare setting
Experience with Cerner, Midas, NaviHealth, and/or GE ID
Experience using Milliman Care Guidelines (MCG) and/or InterQual criteria for medical necessity, setting, level of care, and concurrent patient management
At VCU Health System, our most important assets are not bricks and mortar; they are our team members … all 12,000+ of them. Our workforce is diverse, dedicated and talented. Our team members continue to earn local, regional and national awards and accolades, which is an indicator that they are happy and feel supported working here. And our culture of STAR Service focuses on our common purpose – “Our Caring Service Begins With Me.” – in the provision of the highest level of customer service, which encourages diversity and inclusion.
If you have been looking to take your career to the next level, we have been looking for you. We offer more than 400 work/life benefits including competitive pay, generous benefits, flexible work options, prepaid tuition, on-site child and elder care and much, much more.
EOE M/F/Vets/Disabled. VCUHS appreciates diversity and encourages women, minorities, veterans and persons with disabilities to apply.
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About VCU Health
Every day, there’s a new discovery at VCU Medical Center.
Whether it’s a patient who undergoes a new, life-saving procedure or a clinical researcher who finds promise in a new cancer treatment, exciting medical advances are taking place.
As the only academic medical center in central Virginia, VCU Medical Center is on the forefront of health care, providing patients with the most progressive treatments and medical technology available.