RN Utilization Review Manager
RN Utilization Review Manager
HealthCare Support is actively seeking a RN Utilization Review Manager to fill an opening with a healthcare organization in Houston, TX.
Daily Responsibilities for RN Utilization Review Manager:
1. Conducts monthly audits of UM nurses and UM Coordinators. Audits may be performed more frequently based on results or staff performance indicators.
2. Coordinates clinical rounds and coaches UM nurses in preparing summaries and presenting cases.
3. Works independently and takes initiative to improve UM processes. Participates in work groups and committees.
4. Communicates key information to director and assist director as needed.
5. Responsible for daily operations and ensuring staff assignments support workload.
6. Ensures turnaround time compliance is met with all UM processes, communicates opportunities to director. Works with staff to mitigate and prevent non- compliance.
7. Ensures that staff onboarding and orientation is completed for all UM staff. Makes recommendation to UM trainer.
8. Manages the staffing needs by reviewing analytic reports for productivity, pended cases, average admissions per facility, and complexity if facility needs.
9. Participates in Medical Affairs department programs, focus studies and all initiatives to improve the health and quality of clinical care and service delivery to the Community members and providers.
10. Supports staff with clinical presentations to medical directors.
11. Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans.
12. Demonstrates company values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.
13. Other duties as assigned
Can be fully Remote in but prefer candidates local to Houston.
Shift 8-5 Monday- Friday
Required Qualifications for RN Utilization Review Manager:
BSN degree with active Texas RN license required, MBA, MPH, MHA, and MSN preferred.
Two years of utilization management experience in a Managed Care environment required
Two years supervisory or leadership experience required
Highlight lines of business worked- Texas Medicaid, CHIP, marketplace
Highlight experience – was it inpatient or outpatient
Moderate level of Computer knowledge of MS Word, MS Excel, Outlook, Powerpoint and access data bases
Wants someone with MCO background
Wants someone with experience managing 10+ UM RNs
WIll need to use their OWN EQUIPMENT: 2 screens, will need a headset, high speed internet, (Chromebooks do not work well but MAC or any other seem to work fine)
Benefits for RN Utilization Review Manager:
- Immediate enrollment in Health Insurance
- Dental Insurance
- Life Insurance
- Employee Assistance Program (EAP)
- Access to Investment Accounts
- Career and educational tools within our Ingenovis ACT (Advocacy) Program
Pay Details: $50 – $56 / hour
Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional consideration, please email a copy of your resume to Patrick.Jamito@healthcaresupport.com with your phone number, the job title and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.