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Utilization Management Manager at Magellan HRSC, Inc.

Posted in Nurse 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Richmond, Virginia

Job Description:

This position is responsible for performing concurrent and retrospective utilization review and facilitating discharge planning. The incumbent has access to Protected Health Information (PHI) as needed to accomplish the accountabilities as outlined in this job description.

• Perform concurrent and retrospective utilization review using Interqual criteria to assure that the appropriate level of care is maintained throughout the patient’s hospital stay.
• Provide coordination of complex discharge planning needs and referrals to appropriate support services.
• Prepare and evaluate quality and utilization management reports.
• Participate in clinical rounds and collaborate on post-acute care planning with Care Management colleagues.
• Refer cases to the Medical Director for review as appropriate.
• Provide quality utilization management will reduce health care costs and expenses thereby positively impacting revenues.

General Job Information



Utilization Management Manager



Job Family

Care Management


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications


Associates: Nursing (Required)

License and Certifications - Required

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements


- Minimum of 2 years of prior utilization management experience (admissions, utilization review, and/or discharge planning).
- Strong knowledge of Medicaid / Medicaid programs.
- Knowledge of Interqual.
- Strong clinical and assessment skills.
- Outstanding verbal and written communication skills.
- Ability to work independently and maintain flexibly in fast paced start up environment.
- Ability to analyze data and use it to improve care delivery.
- Self-starter with high level of accountability and responsibility for outcome of care.
- Highly organized and able to manage multiple priorities appropriately.
- Independent problem solving skills.
- Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team.
- Working knowledge of Microsoft Office Product Suite.



Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled