Clinical Utilization Manager
3 weeks ago
We are seeking a highly skilled Clinical Utilization Manager to join our team at Shaker for ChristianaCare Direct. As a key member of our healthcare team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.
About the Role:The Clinical Utilization Manager will be responsible for reviewing medical necessity and collaborating with healthcare providers to ensure that patients receive the most appropriate level of care. This will involve working closely with our Utilization Management team, Denial Manager, Physician Advisor, and other healthcare professionals to identify opportunities for improvement and implement strategies to optimize patient outcomes.
Key Responsibilities:- Perform admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines.
- Collaborate with primary nurses and other healthcare providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
- Manage observation level of care and work with attending physicians and/or clinical providers 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 and facilitate performance improvement measures.
- Monitor efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
- Active DE RN licensure or compact state RN licensure.
- 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.
- Competitive salary and benefits package.
- Opportunities for professional growth and development.
- Collaborative and dynamic work environment.
Shaker for ChristianaCare Direct is a leading healthcare organization dedicated to improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. We are committed to providing exceptional patient care and creating a positive work environment for our employees.
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerWe are seeking a skilled Clinical Utilization Manager to join our team at Shaker for ChristianaCare Direct. 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:The Clinical Utilization Manager will be...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerWe are seeking a skilled Clinical Utilization Manager to join our team at Shaker for ChristianaCare Direct. 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:The Clinical Utilization Manager will be...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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 unique opportunity to work in a dynamic...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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 unique opportunity to work in a dynamic...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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 unique opportunity to work in a dynamic...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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 unique opportunity to work in a dynamic...
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Clinical Utilization Manager
4 weeks ago
Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full timeJob Title: Clinical Utilization ManagerShaker 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 unique opportunity to work in a dynamic...
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