Manager, Utilization Review

Description

Under the administrative supervision of the Director of Case Management, manages the daily activities of Resource Center Associates & Admission Review Nurses to ensure effective processes and successful completion of utilization management, payer communication, authorizations for care provided, and timely progression of care and discharge planning. Supports the efforts of HIM and Patient Accounts by ensuring timely, accurate, and complete data entry in multiple information systems and assisting with denial prevention and management. Brings issues with legal, risk management, or ethical implication to the attention of Director in an expedient manner.

Functions as key contact point for Hospital and maintains excellent working relationships with payers. Participates in strategic planning for the department, working as a member of the case management leadership team. Interviews applicants, makes recommendations for hiring and salary for new employees, completes performance appraisals in a timely manner and employs disciplinary actions as required. Communicates with other departments in the hospital at a high level to ensure that information flow is timely, appropriate and accurate. Represents the department on Committees as indicated. Responsible or performing job duties in accordance with the mission, vision, and values of Tampa General Hospital and the principles of quality improvement.

Qualifications

• Graduate of an accredited School of Nursing; Licensure to practice as a Registered Nurse in the State of Florida.
• Bachelor’s degree in Nursing/Management or related area of study preferred.
• 5 years of clinical experience and a minimum of 5 years experience in utilization management and/or case management required and may substitute for the degree.
• 2 years management experience preferred

Primary Location: Tampa

Work Locations: TGH Main Campus 1 Tampa General Circle Tampa 33601

Eligible for Remote Work: Fully Remote

Job: Accounting/Finance

Schedule: Full-time

Scheduled Days: Monday, Tuesday, Wednesday, Thursday, Friday

Shift: Day Job

Job Type: On Site

Shift Hours: 8-430pm

Minimum Salary: 84,011.20

Job Posting: Jun 6, 2024, 3:19:23 PM