Clinical Utilization Manager

1 week ago


Tulsa, Oklahoma, United States Ascension Full time

Overview


Ascension St. John Medical Center is a leading healthcare provider in Northeast Oklahoma, dedicated to delivering compassionate and personalized care since 1926.


Compensation


The estimated annual salary for this position is $85,000 - $110,000 based on national averages and considering the location in Tulsa, OK.


Job Summary


We are seeking an experienced Clinical Utilization Manager to join our team. The successful candidate will be responsible for reviewing admissions and service requests to ensure medical necessity and compliance with reimbursement policy criteria.


Key Responsibilities:



  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • Prepare statistical analysis and utilization review reports as necessary.
  • Oversight and coordination of compliance to federally mandated and third party payer utilization management rules and regulations.

Requirements


To be considered for this role, candidates must have:



  • A valid Registered Nurse (RN) credential from the Oklahoma Board of Nursing.
  • Diploma from an accredited school/college of nursing or required professional licensure at time of hire.
  • At least 2 years of bedside nursing experience and 2 years of utilization review experience.

Benefits


As a valued member of our team, you will enjoy a comprehensive benefits package that includes:



  • Paid time off (PTO)
  • Various health insurance options & wellness plans
  • Retirement benefits including employer match plans
  • Long-term & short-term disability
  • Employee assistance programs (EAP)
  • Parental leave & adoption assistance
  • Tuition reimbursement
  • Ways to give back to your community

About Ascension


Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.


EEO Statement


Ascension is an Equal Employment Opportunity Employer.


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