Summary
Responsible for the Utilization Review Program across the system. In collaboration with system care coordination leadership ensures the strategic goals for Utilization Review are established and achieved. Establishes policies and procedures that incorporate best practices and standardization across the system. Area of focus is the safe transition of patient throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements.
Responsibilities
•
Monitors and completes utilization review processes
•
Monitors and completes payer communication
•
Denial reduction activities
•
Provided direction and guidance to others regarding practice
•
Monitors and completes ongoing performance improvement
•
Serves as a resource and mentor
•
Performs other duties as assigned
Requirements, Preferences and Experience
Experience:
Minimum-RN with 5 years of clinical experience at least 2 of which involve Utilization Review or Case Management
Preferred-RN with 7 years of clinical experience with Utilization Review or Case Management experience in a hospital or payer setting
Education:
Minimum-Diploma or Associate Degree in Nursing
Preferred-BSN or MSN
Training:
Preferred-Certified CM
Special Skills:
Minimum-Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Licensure:
Minimum-RN
Preferred-CCM; ACM
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.
At Baptist, We Offer:

• Competitive salaries
• Paid vacation/time off
• Continuing education opportunities
• Generous retirement plan
• Health insurance, including dental and vision
• Sick leave
• Service awards
• Free parking
• Short-term disability
• Life insurance
• Health care and dependent care spending accounts
• Education assistance/continuing education
• Employee referral program

Job Summary:
Position: 18373 - System Manager-Utilization Review
Facility: BMHCC Corporate Office
Department: HS Case Mgmt Administration Corporate
Category: Leadership & Administration
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:TN:Memphis
Located in the Memphis metro area