Program Manager, Hospital Utilization Management

Regions Hospital is seeking an individual with a strong clinical background and analytical skills to join our Utilization Management department as a Program Manager.

The Utilization Management (UM) Program Manager provides oversight for the UM program to ensure consistent, effective and efficient delivery of all utilization management functions across the enterprise. This position has expert knowledge of regulatory bodies and payer requirements to ensure compliance in all areas. He/she serves as the subject matter expert in all areas of UM and is accountable to stakeholders for ongoing assessment and outcome reporting of the UM program. The Program Manager will be a key contributor for developing a comprehensive UM program, implementing supporting software and managing all components of the program. This position works closely with the operational leaders on standardized training and processes to ensure reliable program delivery. The UM Program Manager partners with physician advisors to ensure quality medical necessity reviews and successful peer-to-peer clinical discussions are completed. In conjunction with the Operations Director and Medical Director of UM this position will be responsible to deliver a highly reliable program that promotes accurate patient status, appropriate length of stay, denial management and overall maximum reimbursement.

Work Schedule:

Monday through Friday

Required Qualifications:

• Bachelor's degree in Nursing, Healthcare Management or Business Administration required.
• Minimum of 5 years clinical practice in health care setting
• Minimum of 5 years utilization review/management
• Current license as a Registered Nurse in State of Minnesota

Preferred Qualifications:

• Master's degree in Organizational leadership, Healthcare Administration, Business administration, or Nursing
• Multi-site leadership, Program Integration

Benefits:

Regions Hospital offers a competitive benefits package (.5 FTE or greater) that includes medical insurance, dental insurance, 401K with match, disability insurance, and tuition reimbursement. Benefits take effect first day of employment. We offer an on-site employee fitness center, an on-site physical therapy clinic for employees as well as on-site employee clinic to make it more convenient for our staff to get the care they need. We also have a Center for Employee Resilience that provides support and evidence-based practices to bring relief and build resiliency. Regions Hospital is a qualified non-profit employer under the federal Public Service Laon Forgiveness program. Regions is also proud to be a Yellow Ribbon Company.