RN Utilization Review Manager

Are you a highly skilled and experienced Registered Nurse looking for an exciting new opportunity? Are you passionate about ensuring the delivery of high-quality, cost-effective healthcare services? BJC HealthCare is seeking a dynamic RN Utilization Review Manager to join our team. In this role, you will be responsible for overseeing utilization review activities to optimize patient outcomes and resource utilization. We are looking for a self-motivated and detail-oriented individual with a strong background in healthcare management and utilization review. If you are ready to take the next step in your nursing career and make a significant impact on patient care, we encourage you to apply for this position today.

1. Develop and implement utilization review protocols and procedures to ensure the efficient and effective use of healthcare resources.
2. Oversee a team of utilization review nurses and ensure their adherence to established protocols and procedures.
3. Collaborate with healthcare providers and insurance companies to ensure timely and accurate authorization of medical services.
4. Monitor and analyze utilization data to identify opportunities for improvement and cost-saving measures.
5. Develop and maintain relationships with healthcare providers to facilitate communication and collaboration.
6. Conduct regular audits to ensure compliance with regulatory and accrediting agency requirements.
7. Provide guidance and support to clinical staff regarding utilization management and documentation practices.
8. Serve as a liaison between healthcare providers, insurance companies, and patients to resolve any utilization review issues.
9. Develop and deliver training programs for staff on utilization review processes and procedures.
10. Stay updated on industry trends and best practices in utilization management to continuously improve processes and outcomes.
11. Participate in performance improvement initiatives and provide recommendations for enhancing utilization review processes.
12. Ensure the confidentiality and security of patient information in accordance with HIPAA regulations.
13. Collaborate with other departments, such as case management and finance, to streamline utilization review processes.
14. Maintain accurate and timely documentation of all utilization review activities.
15. Act as a resource for staff regarding utilization review questions and concerns.

According to JobzMall, the average salary range for a RN Utilization Review Manager in St. Louis, MO, USA is $80,000 - $102,000 per year. This can vary depending on factors such as experience, education, and specific job responsibilities.

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, serving metro St. Louis, mid-Missouri and Southern Illinois. In 1993, Barnes-Jewish Inc., an urban, academic medical center affiliated with Washington University School of Medicine; and Christian Health Services, a suburban community hospital network, merge to form BJC Health System.