Senior Utilization Management Manager Job in Columbus, Ohio Us

A Senior Utilization Management Manager will be responsible to build and manage a strong team of utilization review nurses and social workers.  As well as the following:

·         Perform technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities;   

·         Utilize pre-approved criteria and guidelines to validate medical necessity;

·         Perform on-site and/or telephonic review of psychiatric services;

·         Identify and report any quality or utilization issues to the Medical Director;  

·         Function as a resource to the clinical team regarding approved criteria and practice guidelines;

·         Provide utilization management education to a diverse group of health care providers;

·         Utilize excellent customer service principles to assist internal and external customers;

·         Participate in the quality improvement process; and

·         Maintain member confidentiality.

 

Basic Qualifications

·         Bachelor’s degree in nursing, business, or public administration

·         Registered nurse with an unrestricted license in the State of Ohio

·         A minimum of five years experience in utilization management

·         Experience in psychiatric care

·         Project management knowledge

·         Supervisor experience

·         Demonstrated team leadership abilities and customer focus

·         Proficiency with Microsoft Office applications

·         Excellent oral and written communication skills as demonstrated by the ability to convey information and directions clearly and concisely

·         Strong organizational and prioritization skills as demonstrated by the ability to handle multiple tasks concurrently and appropriately prioritize assignments for staff.

·         Must be able to operate a motor vehicle and travel approximately 30 to 40% of the time

 

 

Preferred Qualifications

·         Master's degree

·         Certified Professional in Utilization Review