Manager, Utilization, Full Time, Day

Responsible for development and implementation of hospital –wide system / processes for Utilization Management, Denials /Appeals Management, Resource / LOS management. Accountable for directing the day-to-day operations for Concurrent Utilization Review processes for Medicare, Medicaid, Managed Care and Commercial Payors, Oversight of all inpatient Denials and Appeals activity i.e. Medicare RAC Denials, Managed Care Denials, Medicaid Denials and oversight of hospital specific managed care contract requirements. Works to appropriately maximize revenue for every patient bed in collaboration with clinical and financial teams. Interfaces extensively with insurance companies to ensure certification and payment for episodes of care.

Bachelor's degree required. Licensure and/or certification as required. Current and Valid State of New Jersey license required. Certification CPUR, CPHQ or CCM preferred. Minimum 5-7 years experience in utilization management, quality improvement or a related area.

Demonstrated managerial skills as required for the position.

Skills
* Magnet recognized national certification preferred, but RN management is expected to have Magnet recognized national certification within two years of hire into position.

Job Location

Shift

EEO Statement

Valley Health System does not discriminate on the basis of ancestry, age, atypical hereditary cellular or blood trait, civil union status, color, creed, disability, domestic partnership, gender, gender identity or expression, familial status, genetic information, liability for service in the Armed Forces of the United States, marital status, medical condition or illness, mental or physical handicap, national origin, nationality, perceived disability, pregnancy, race, refusal to submit to genetic testing or make available results of such tests, religion, sex, sexual orientation, veteran’s status or any other protected basis, in accordance with all applicable Federal, State and Local laws. This applies to all areas of employment, including recruitment, hiring, training and development, promotion, transfer, termination, layoff, compensation, benefits, social and recreational programs, and all other conditions and privileges of employment.