Manager - Utilization Management Job Description





Job Summary:

The Manager - Utilization Management is responsible for the management of utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). He/She will perform reviews of current inpatient services; determine medical appropriateness of inpatient and
outpatient services following evaluation of medical guidelines and benefit determination.  

Job Description:

The Manager - Utilization Management will perform all or some of the following Job description:

  • Manage and accountable for professional employees and/or supervisors

  • Set team direction, resolve problems and provide guidance to members of own team

  • May oversee work activities of other supervisors

  • Adapt departmental plans and priorities to address business and operational challenges

  • Influence or provide input to forecasting and planning activities

  • Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external).

Minimum Requirements / Knowledge / Skill For Manager - Utilization Management Job

  • Previous management experience in a health care related field preferred

  • Case management experience desired

  • Ability to travel

  • Excellent verbal and written communication skills required

  • Excellent organizational skills

  • Proficient in MS office (including Word and Excel)

  • Active, unrestricted RN license.

Minimum Education Requirements / Certification / Licensure For Manager - Utilization Management Job

  • Undergraduate degree or equivalent experience.


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