Utilization Management Manager at Magellan HRSC, Inc.
Posted in Nurse 30+ days ago.
This job brought to you by eQuest
Location: Richmond, Virginia
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
TitleUtilization Management Manager
Job FamilyCare Management
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date3/6/2018
Date Requisition Created1/26/2018
EducationAssociates: Nursing (Required)
License and Certifications - RequiredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
Responsibilities- 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