Utilization Review Nurse Manager

Responsible for review of Care Management and Utilization Review services including acting as client liaison, managing clinical staff, monitoring production activity and producing and/or reviewing client reports.

Responsibilities

• Monitor all CM/UR clients’ review volumes to ensure adequate staffing coverage, including developing and maintaining the monthly CM/UR staffing schedule.

• Train and mentor assigned staff including back-up and cross training in all necessary job functions.

• Review quality review results for each clinical staff member on a monthly basis and addressing performance issues as required

• Review and approve time worked and expense reports for all assigned clinicians.

• Prepare work plans for new CM/UR engagements and timelines for implementation of CM/UR coverage support

• Travel to client sites to assist in designing and implementing logistics to successfully implement new engagements.

• Ensure smooth implementation of client engagements

• Assist in preparation or review of status reports and other monthly activity reports to clients.

• Coordinate and lead client status meetings

• Ensure all CM/UR review timeframes and client deadlines are met.

• Develop and analyze productivity reports, trending analysis, impact on client denial rates, and other management reporting as needed.

• Maximize the use of internal systems to enhance workflow and improve productivity.

• Maintain positive working relationships with clients’ medical staff, case management staff, revenue cycle management and administration.

Qualifications

Basic

• Bachelor's of Science in Nursing (BSN) or equivalent degree

• Active RN state licensure

• At least 3 years of experience as a Case Manager or Utilization Review Nurse

• At least 3 years of people management experience

• Experience using InterQual Criteria and MCG Care Guidelines

• Experience with Care Management systems such as Allscripts, Epic, Cerner, etc.

• Attention to detail and the ability to resolve complex issues quickly and appropriately.

• Experience with Microsoft Excel and Word

• Ability to develop, interpret and analyze management reports

• Ability to navigate and manage multiple systems simultaneously on a laptop computer

• Ability to effectively communicate with internal personnel as well as client management personnel

• Strong verbal and written communication skills

Preferred

• Experience as a Case Manager or Utilization Review RN within ED Case Management

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

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