Clinical Utilization Manager

4 days ago


Lincoln, Nebraska, United States Bryan Health Full time
Job Summary

Bryan Health is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our healthcare team, you will be responsible for conducting day-to-day activities related to the clinical, financial, and utilization coordination of patient hospital experiences.

Key Responsibilities
  • Conducts utilization reviews, including concurrent and retrospective reviews, to determine medical necessity and ensure compliance with regulatory requirements.
  • Collaborates with healthcare teams to manage patient length of stay and determine continuing medical necessity.
  • Refers cases to reviewing physicians when treatment requests do not meet criteria.
  • Participates in concurrent and retrospective denials and appeals processes.
  • Serves as an internal and external resource for appropriate level of care, admission status, and regulatory requirements.
Requirements
  • Current Registered Nurse licensure from the State of Nebraska or approved compact state.
  • Minimum of two years recent clinical experience required.
  • Prior care coordination and/or utilization management experience preferred.
Preferred Qualifications
  • Basic Life Support (CPR) certification.
About Bryan Health

Bryan Health is a leading healthcare provider in the region, committed to delivering high-quality patient care and exceptional service. We are dedicated to creating a positive and supportive work environment that fosters growth and development.



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