Qualifications

MINIMUM EDUCATION: Graduate from an accredited school of nursing.

PREFERRED EDUCATION: Bachelor of Science in Nursing.

MINIMUM EXPERIENCE: Two (2) years acute hospital patient care, hospital case management, utilization review, healthcare, or leadership experience.

PREFERRED EXPERIENCE: Acute hospital case management or supervisory experience.

REQUIRED CERTIFICATIONS/LICENSURE: Registered Nurse. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.

PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Manager (ACM)

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Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law. 

Description

POSITION SUMMARY

The Manager of Utilization Review facilitates and supports an effective Utilization Review program within the Utilization Review department, which may be centralized within a specific market or group. The position has overall responsibility to ensure care is provided at the appropriate level of care based on medical necessity and assess the patient or transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. The position manages medical necessity process for accurate and timely payment of services which may require negotiations with payer on a case-by-case basis. The UR Manager integrates national standards for case management scope of services. Assists the Group Director in support of the advancement of Centralized Utilization Review as a leader, mentor, and consultant. Assists the Group Director with executing on strategic initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations. Other related duties as assigned

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