Description

Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, Whittier, and East Lake Street neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.  

Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieve optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and working in an environment that celebrates, promotes, and protects diversity, equity, inclusion, and belonging. We are committed to bringing in individuals with new cultural perspectives to assist in creating a more equitable healthcare organization.

 
SUMMARY:

We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a full-time role and will be required to work onsite. 

Purpose of this position: Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. Functions as the internal resource on issues related to the appropriate utilization of resources, coordination of payer communication, and utilization review and management. Responsible for carrying out duties in a manner to assure success in financial management, human resources management, leadership, quality, and operational management objectives. Participates in program development and UR Department performance improvement. Responsible for day-to-day operations of the department, assists with the budgeting process, assists with personnel recruitment, retention, corrective action, and professional development. 

Requirements

QUALIFICATIONS:

Minimum Qualifications:

• Master’s degree in nursing or related field. If the Master’s degree is in a related field, the individual must have a Bachelor’s degree in Nursing from an accredited program
• Individuals who do not have a Master’s degree in either nursing or a related field must have a Bachelor’s degree in Nursing and be actively enrolled in an approved Master’s or Doctorate nursing or related field program. Enrollment in the progressive ADN to Master’s Degree Program also fulfills this requirement. The Master’s or Doctorate degree must be obtained within 5 years of hire as a condition of continued employment
• Three to five (3 to 5) years of professional leadership experience (i.e., charge nurse, team leader, preceptor, committee chair, etc.)
• Five (5) years clinical experience
• A minimum of one (1) year of utilization review experience
• Current Registered Nurse licensure upon hire

Preferred Qualifications:

• Masters’ degree
• Experience in surgery, emergency and/or critical care
• Experience in process/quality improvement, quality measurement, data abstraction, data analysis and reporting, and data integrity

Knowledge/ Skills/ Abilities:

Ability to deliver financial results for areas of accountability
Knowledge of or ability to learn financial management related to UR function and reporting, quality improvement processes, and human
resources management
Able to effectively monitor, evaluate and administer the resources of each assigned area, and make substantiated recommendations regarding
resource allocation needs for future planning purposes
Able to communicate effectively in writing and verbally, ability to interact with a wide variety of individuals, and handle complex and confidential
situations
Ability to lead, delegate, analyze information and problem solve
Demonstrates evidence of strong skills in confidentiality, integrity, creativity, and initiative

License/Certifications:

National certification of any of the following: CPHM (Certified Professional in Healthcare Management), CCM (Certified Case Manager), ACM (Accredited Case Manager) required or completed within three years of hire