What are the responsibilities and job description for the Utilization Review Manager position at South Carolina Region?
East Cooper Medical Center is one of South Carolina's leaders in healthcare. Our approach to medicine is designed to provide patients with successful outcomes, fast recovery times, and a better quality of life. Our hospital combines technology and clinical expertise with compassion to provide personalized care for a lifetime. Our expanded scope of services, our commitment to quality & safety, and our outstanding team of caregivers have attracted patients throughout the Lowcountry and beyond, and have contributed to or hospital being nationally recognized. Interested in joining our team? Apply today!
Position Summary
The team member’s Number One job responsibility is to deliver the most remarkable patient experience, in every dimension, every time, and understands how to contribute to the health system’s vision of achieving that commitment to patients and families. At Novant Health, people are our business. We treat each other with respect and compassion. We embrace the differences in our strengths while fostering an environment of inclusion, empowerment, inspiration and courage. The team member will use Novant Health’s First Do No Harm (NHFDNH) safety behaviors/error prevention tools and high reliability strategies as appropriate to ensure a safe, remarkable patient experience.
The Manager of Utilization Review is responsible for oversight and management, operations and ongoing quality, productivity and efficiency for utilization review processes.
Responsible for maintaining appropriate compliance with government payer regulations and commercial payer requirements as it relates to initial, concurrent and retrospective medical necessity reviews through timely, efficient and accurate processes.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Current license as a Registered Nurse in the State of South Carolina.
BSN required; MSN preferred.
Minimum of three (3) years of hospital-based clinical experience required.
Previous Utilization Review or Discharge Planning experience desirable.
Requires effective communication with patients, families, nursing, medical staff, and ancillary departments.
Ability to take initiative to resolve problems immediately and implement change in a timely basis.
Must be self-directed and able to adapt to change.
