4 Manager Utilization Management-RN Jobs in Lebanon, NH

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Manager Utilization Management-RN

Dartmouth-Hitchcock Health

Lebanon, NH | Full Time

$108k-136k (estimate)

2 Months Ago

Manager Utilization Management-RN

D-H Medical Center

Lebanon, NH | Full Time

$110k-137k (estimate)

2 Months Ago

Utilization Management, Manager. Registered Nurse, RN

Dartmouth Health

Lebanon, NH | Full Time

$94k-116k (estimate)

2 Weeks Ago

Utilization Management, Manager. Registered Nurse, RN

Dartmouth Health | D-H Medical Center

Lebanon, NH | Full Time

$100k-128k (estimate)

3 Weeks Ago

Manager Utilization Management-RN

$108k-136k (estimate)

Full Time | Ambulatory Healthcare Services 2 Months Ago

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Dartmouth-Hitchcock Health is Hiring a Manager Utilization Management-RN Near Lebanon, NH

Overview:

Manages team and processes to ensure patients are placed in the appropriate status. Ensure adherence to Conditions of Participation and other applicable regulatory standards.

Responsibilities:

Supervises assigned personnel. Selects, counsels, prepares performance evaluations, and terminates according to policy. Monitors and provides education on key regulatory changes.
Establish ambulatory and inpatient procedure list, updates and maintains list.
Identifies clinical areas that require intervention and education regarding the use of patient status requirements.
Works with physician offices and outside reimbursement vendor (Conifer) staff on pre-certifications related to patient status.
Assumes responsibility for the oversight of inpatient denials workgroup, including, but not limited to, reviewing denial letters, collaborating with the appropriate individuals to determine the decision to appeal or accept, assisting in the response to Health Plan, etc.
Develops and implements communication strategies to keep clinicians and staff informed of changes and current practice.
Report on key metrics for program including; length of stay, readmission rates, prior approval/pre-certifications and denials.
Provides information to departmental leadership that reflects trends and practices that may need organization, intervention, and change.
Collaborates with peers and vendor on new or revised Health Plan contracts and changes in governmental reimbursement.
Collaborates with Health Plans to understand their definitions, articulates the definitions of D-H, and assists in the development of strategies for resolution of differences.
Benchmarks with other facilities concerning admission and denial experience and policies.
Performs other duties as required or assigned.

Qualifications: