Nurse Manager

1 month ago


Montgomery, Alabama, United States Baptist Health Full time
Job Title: Nurse Manager - Utilization Review

Baptist Health is a leading healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit our website.

Job Summary

The RN - Utilization Review Nurse Manager shall oversee the daily Utilization Review and Appeals Management processes for the facilities within Baptist Health. This individual shall administer policies and operational procedures necessary to coordinate the resources needed for utilization review and appeal management. Additionally, the Manager shall be responsible for allocation and management of human resources in assigned departments.

Key Responsibilities
  • Develop and implement utilization review protocols
  • Collaborate with various departments to optimize resource utilization
  • Manage a team of Utilization Review and Appeal Management Specialists
  • Coordinate care of patients through collaboration with physicians, nursing staff and other health professionals
  • Foster a cooperative work environment and promote physician, patient and employee satisfaction
Requirements
  • Degree in Nursing, Master's degree preferred
  • Minimum 3-5 years' hospital-based experience in concurrent utilization review required
  • Minimum 3-5 years of hospital-based appeals management experience required
  • Minimum 3-5 years' experience in third party payor requirements required
  • Minimum 3-5 years of similar leadership experience required
  • Knowledge of Joint Commission and CMS Conditions of Participation preferred
  • Active RN licensure required
  • Change Healthcare InterQual Certified Expert Resource Certification required or will acquire within year of hire
  • Certified Case Manager (CCM) certification preferred
Preferred Qualifications
  • Excellent interpersonal skills and the ability to work under stressful conditions
  • Knowledge of generally accepted hospital policies and procedures
  • Organizational skills
  • Good written and oral communication skills
  • Ability to foster a cooperative work environment
  • Effective supervisory and leadership skills
  • Strong customer service skills
  • Ability to resolve customer complaints and concerns
  • Employee development and performance management skill

Baptist Health is an equal opportunity employer and welcomes applications from diverse candidates.



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