System Utilization Review Nurse Manager

Baptist Health is the largest 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 us at https://www.baptistfirst.org.
The RN - Utilization Review Nurse Manager shall manage 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. The Manager is responsible to manage a team of Utilization Review and Appeal Management Specialists, to develop and implement utilization review protocols, and collaborate with various departments to optimize resource utilization. The Manager will coordinate care of patients through collaboration with physicians, nursing staff and other health professionals. The position facilitates efficient utilization of resources; optimize clinical and financial outcomes; while promoting physician, patient and employee satisfaction. This position may have additional duties assigned that are within scope of the role.Description

• 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.
  
  • 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