UM Clinical Denial Manager
UM Clinical Denial Manager
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
We are so glad you are interested in joining Sutter Health!
Organization:
SHSOSutter Health System OfficeValleyPosition Overview:
Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance with current federal and state regulations and guidelines. Has frequent contact with hospital leadership Nurse Executives and Directors Risk Management & Ethics staff Ancillary Services Revenue Cycle and Finance Department leaders Medical Directors Medical Staff leaders physicians contracted providers community resources postacute agencies patients and their families.Job Description:
EDUCATION:
* Graduate of an accredited school of nursing
CERTIFICATION & LICENSURE:
* RNRegistered Nurse of California Upon Hire
TYPICAL EXPERIENCE:
*8 years of recent relevant experience.
*2 years experience in Utilization Management (UM) and Clinical Denial Management Preferred
SKILLS AND KNOWLEDGE:
* Knowledge of ACMA CMSA and NASW Standards of Practice.
* Knowledge of available health care and community resources
* A broad knowledge base of health care delivery and case management within a managed care environment.
* Comprehensive knowledge of laws regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS Title 22 CHA Consent Manual CDPH and TJC.
* Verbal and written communication skills.
* Group presentation design and facilitation skills.
* Demonstrated ability to develop and manage complex projects.
* Working knowledge of InterQual criteria.
* Working knowledge of MIDAS and experience with an E.H.R. (EPIC preferred)
* Ability to promote teamwork and to effectively function in teams both as a leader and as a team member.
* Ability to interact effectively with key internal and external constituents using collaboration negotiation and analytical problem resolution skills.
* Effective human relations and interpersonal skills necessary to lead the efforts of diverse health professionals to meet program objectives.
* Ability to work effectively in a fast paced environment directing services at multiple locations.
* Analytical and mathematical skills.
* Demonstrated ability to implement continuous quality improvement processes and techniques including benchmarking and outcomes measurements.
* PC skills word processing spreadsheets and managed care software programs.
* Adheres to Sutter health policies and procedures and supports Sutter health philosophies and initiatives. Participates as member of the utilization
* Management committee (UMC).
* Strong problem resolution abilities and customer relation skills
Job Shift:
DaysSchedule:
Full TimeDays of the Week:
Monday FridayWeekend Requirements:
As NeededBenefits:
YesUnions:
NoPosition Status:
ExemptWeekly Hours:
40Employee Status:
RegularSutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $83.00 to $132.80 / hourThe salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidates experience education skills licensure and certifications department equity training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
Required Experience:
Manager
Employment Type
Full-Time
