RN Nurse Manager – Utilization Review

Job Description

Networks Connect is seeking an experienced RN Nurse Manager – Utilization Review to lead and manage our Utilization Review and Clinical Documentation Improvement departments for our client, a prominent healthcare system in Washington, DC. This position involves supervising daily operations, providing education on clinical and financial issues, and leading hospital-wide initiatives to optimize performance and documentation practices.

Key Responsibilities

• Supervision and Evaluation: Manage and evaluate the daily activities of the Utilization Review and Clinical Documentation Improvement teams according to organizational policies.
• Education and Training: Educate staff and organization on clinical care levels, financial issues, and documentation guidelines. Provide ongoing training to improve staff skills and knowledge.
• Data Analysis and Reporting: Analyze and report on case management activities, payer activities, resource utilization, and clinical denials. Monitor and report the effectiveness of process improvements.
• Operations Management: Ensure adequate staffing coverage, optimize productivity, and manage departmental budgets. Address issues with payers and enhance authorization processes.
• Clinical Documentation Improvement: Partner with coding leadership to improve documentation accuracy and compliance. Develop and implement education strategies for physicians and healthcare teams.
• Relationship Building: Establish effective relationships internally and externally to achieve departmental and organizational goals. Represent CRM and CDI on organizational committees.
• Performance Improvement: Ensure compliance with regulatory standards, track performance data, and implement processes to reduce denials and optimize reimbursement.

Qualifications

Education:

• Master’s Degree in Nursing or a related field (Required).

Experience:

• 7 years of healthcare experience (Required).
• 3 years of supervisory experience (Required).

Skills and Knowledge:

• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access).
• Excellent communication skills.
• Knowledge of children’s health issues and cultural impacts on healthcare.
• Experience with medical management criteria (Milliman, InterQual).
• Ability to analyze and present productivity and outcome data.
• Licenses and Certifications:
• Registered Nurse in the District of Columbia (Required).
• Basic Life Support for Healthcare Provider (BLS) (Required).
• Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) (Preferred).
• Case Management Certification (CCM or CMSA) (Preferred).

Work Environment

Location: Washington, DC

Schedule: Full-time, Monday to Friday, 8:30 AM – 5:00 PM

Join our client’s team to lead and innovate in the Utilization Review and Clinical Documentation Improvement departments, ensuring high-quality care and optimal documentation practices. Apply now to be part of their dedicated healthcare system focused on excellence and continuous improvement.

Earnings

$110,000 - $130,000 salary

Category

Revenue Cycle