Summary Responsible for the Utilization Review Program across the system. In collaboration with system care coordination leadership ensures the strategic goals for Utilization Review are established and achieved. Establishes policies and procedures that incorporate best practices and standardization across the system. Area of focus is the safe transition of patient throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Responsibilities Monitors and completes utilization review processes Monitors and completes payer communication Denial reduction activities Provided direction and guidance to others regarding practice Monitors and completes ongoing performance improvement Serves as a resource and mentor Performs other duties as assignedRequirements, Preferences and Experience Experience: Minimum-RN with 5 years of clinical experience at least 2 of which involve Utilization Review or Case ManagementPreferred-RN with 7 years of clinical experience with Utilization Review or Case Management experience in a hospital or payer settingEducation:Minimum-Diploma or Associate Degree in NursingPreferred-BSN or MSNTraining:Preferred-Certified CMSpecial Skills:Minimum-Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.Licensure:Minimum-RNPreferred-CCM; ACMAbout Baptist Memorial Health Care At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.At Baptist, We Offer:
Competitive salaries
Paid vacation/time off
Continuing education opportunities
Generous retirement plan
Health insurance, including dental and vision
Sick leave
Service awards
Free parking
Short-term disability
Life insurance
Health care and dependent care spending accounts
Education assistance/continuing education
Employee referral program
Job Summary: Position: 18373 - System Manager-Utilization ReviewFacility: BMHCC Corporate OfficeDepartment: HS Case Mgmt Administration CorporateCategory: Leadership & AdministrationType: Non ClinicalWork Type: Full TimeWork Schedule: DaysLocation: US:TN:MemphisLocated in the Memphis metro area REQNUMBER: 21868