Utilization Review Manager
Minneapolis, MN
AMN Healthcare Revenue Cycle
5x8 hrs

Job Description & Requirements
Manager, Utilization Review (Remote)
StartDate: ASAP Pay Rate: $1800.00 - $2500.00

POSITION SUMMARY 
Manager, Utilization Review (Remote) 

POSITION DUTIES 

• Participates in the development and management of department budgets and productivity targets
• Directs and manages team of UR Coordinators, promotes employee satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
• Collaborates with department director and professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity screening to ensure patients are placed at the appropriate patient status and level of care, professional communication with physicians and nurses and other members of the care team
• Collaborates with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity and patient status
• Ensures processes are in place for proactive reviews of surgical and other procedures to confirm accurate perioperative pre-authorization and patient class order reconciliation process. Assesses compliance to regulatory and health plan requirements for authorization, including Medicare
• Inpatient Only List and communicates to provider to obtain accurate order prior to procedure and post procedure
• Ensures UR Coordinators and Clinical Coordinators identify, document, and communicate avoidable days and delays in services that may prolong length of stay; analyzes data to monitor trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and actions to UR Committees, as appropriate
• Partners with Physician Advisor to engage in second level review and working with attending physicians to document completely to ensure patient class determinations
• Serves as expert resource for all Medicare Notification Letters and ensures appropriate distribution of all letters (IMM, MOON, HINN, etc.) including full documentation to meet regulatory requirements and ensure correct billing
• Works collaboratively with Inpatient Care Management, Patient Accounting, Patient Admission and Registration, HIM, and the Finance Department to analyze one-day Medicare inpatient stays and identify opportunities to improve
• Develops and implements process to manage and respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be medically inappropriate. Including, but not limited to; Peer-to-Peer as appropriate, written appeal letters when indicated, documentation of interventions and outcomes and monitor to identify opportunities to improve processes for denial
• prevention
• Serves as the internal expert on documentation and reimbursement requirements. Serves as a resource to the health care team for utilization and denial management. Liaises with provider office staff and facilitates meetings with payers, as appropriate
• May participate in the Utilization Review Committee to present medical necessity data and outcomes and partners with care management leadership to develop action plans for improvement
• Performs other duties as assigned

MINIMUM REQUIRED QUALIFICATIONS 

• Bachelors degree in nursing or related field
• Three to five (3 to 5) years of leadership experience (i.e., charge nurse, team leader, preceptor, committee chair, etc.)
• Five (5) years clinical experience.
• A minimum of two (2) years of utilization review experience
• Current Registered Nurse licensure from the Minnesota Board of Nursing upon hire

PREFERRED QUALIFICATIONS 

• Masters’ degree
• CPHM (Certified Professional in Healthcare Management), CCM (Certified Case Manager), or ACM (Accredited Case Manager)
• Experience in surgery, emergency and/or critical care
• Experience in process/quality improvement, quality measurement, data abstraction, data analysis and reporting, and data integrity

LENGTH OF ASSIGNMENT 
Permanent, Direct Hire 

SHIFT / HOURS PER WEEK 
Full-time, Days

SYSTEMS
Epic, InterQual 
START DATE 
ASAP


Facility Location
Straddling the Mississippi River, this gleaming metropolis offers all the sophistication of a major urban center with four distinct, vibrant seasons. Named the “Most Fun City in America” by Money Magazine, Minneapolis boasts the largest indoor shopping mall in the nation, a thriving art and music scene, energetic neighborhoods and a variety of great restaurants and entertainment

Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.