Clinical Utilization Manager

1 week ago

Newark, Delaware, United States Shaker for ChristianaCare Direct Full time
Job Title: Clinical Utilization Manager

Shaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.

About the Role:

This is a challenging and rewarding opportunity for a Registered Nurse with experience in Utilization Management to work in an acute care hospital setting. You will be responsible for reviewing medical necessity, collaborating with healthcare providers, and ensuring the efficient use of healthcare services.

Key Responsibilities:
  • Perform admission and concurrent reviews to identify medical necessity and level of care
  • Collaborate with primary nurses and healthcare providers to ensure a multidisciplinary plan-of-care is in place
  • Manage observation level of care and work with attending physicians to ensure observation status does not exceed 48 hours
  • Identify system issues that serve as barriers to care and participate in development and implementation of strategies to remove barriers
  • Monitor efficiencies in scheduling diagnostic procedures and coordination of treatments
  • Report information generated from the utilization management referral process
  • Collaborate with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals
Requirements:
  • Bachelor's degree in nursing
  • Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting
  • Clinical documentation, performance improvement, case management, or utilization management experience desirable
  • Ability to ambulate within the hospital setting and utilize computer equipment/programs
What We Offer:
  • Medical, dental, vision, life insurance, and tuition assistance
  • Two retirement planning offerings, including 403(b) with company contributions
  • Generous paid time off with annual rollover and opportunities to cash out
  • 12-week paid parental leave
  • Incredible work/life benefits, including annual membership to, access to backup care services for dependents through, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors
About Us:

Christiana Care is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. We offer a comprehensive range of services, including outpatient services, home health care, urgent care centers, three hospitals, a free-standing emergency department, a Level I trauma center, a Level III neonatal intensive care unit, a comprehensive stroke center, and regional centers of excellence in heart and vascular care, cancer care, and women's health.

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