Utilization Review Manager
- Job Title
- Utilization Review Manager
- Job ID
- Washington, DC 20060
- Other Location
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nation’s only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Utilization Review Manager who will embrace our reach and historic tradition of excellence. If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.
Culture of Care Statement: In an effort to improve patient safety, Howard University Hospital (HUH) supports a Just Culture. This atmosphere of accountability promotes the identification of human error (mistake), at-risk behavior (behavioral choice that increases risk) and reckless behavior (disregard for risk). The goal is to maintain a culture for learning, safe systems and well managed behavioral choices.
The hours for this position are Monday-Friday 8:30 a.m.-5:00 p.m.
The Utilization Review Manager provides quality oversight functions to ensure a departmental structure that’s supports superior outcomes and responsible to operationalize the strategic plan for the department. The position is responsible for managing personnel who support utilization management, case management and care coordination transition planning activities. This position ensures compliance with state, federal and other regulatory accreditation standards. The manager will role model professionalism and exemplary standards of practice while mentoring, evaluating, and facilitating the professional growth of their team. Performs principle duties and responsibilities in a manner consistent with the Organization’s mission, values and goals.
The Utilization Review Manager:
- Manage the day to day operations of the Utilization Review and Case Management staff.
- Conducts case level audit reviews and provides feedback to utilization review and case management staff on a regular basis. Provides support and oversight of UR and CM activities to ensure appropriate use of established guidelines, policies and procedures. Ensures compliance with state, federal and other regulatory accreditation standards.
- Direct utilization review and case management activities to secure effective reimbursement for the care provided in the hospital and ensure appropriate length of stay.
- Provides quality oversight to ensure appeals are sent out timely. Prepares and submits utilization review and case management reports.
- Maintains effective working relationships with internal and external stakeholders to include physicians, health care team, community providers, insurers and others.
- Participates in plan of care rounds to ensure seamless and effective transitions of care.
- Conducts performance evaluations, provides coaching and acts as a mentor to direct reports. Supports educational growth by providing education, training, and appropriate resources.
- Directs performance improvement projects as indicated. Other duties as assigned.
Required Qualifications: Competencies:
- Expert knowledge of CMS and evidence-based utilization review guidelines. Working knowledge of state, federal and other regulatory accreditation standards
- Excellent communication skills to facilitate timely discharge planning with doctors, nurses, home health companies and, other healthcare personnel and agencies. Exceptional interpersonal skills including collaboration and ability to relate to other disciplines.
- Coordinating healthcare services in the community with clinical judgment.
- Understanding various medical conditions and terminology to better serve the patient and give feedback to medical team
- Ability to evaluate the mental, emotional and physical status of patients. Ability to apply interviewing skills like active listening, open ended questions, etc. to elicit answers that can assist in the patient’s care
- Maintains a climate that attracts, retains and motivates staff. Working knowledge and practice of leading a team
- Excellent computer skills and the ability to manage computer files, operate office equipment and use of EHR
- Strong written and verbal communication and customer service skills.
Required Qualifications: Education and Experience:
- Bachelor of Science Nursing required, Master’s degree preferred
- 3-5 years utilization review, discharge planning, and/or case management
- 1 -2 years prior supervisory experience.
- Active and unencumbered RN License in the District of Columbia, required
- Case Management Certification (CCM) preferred.
At Howard University Hospital our job is to care for you. We do this by offering:
- Work life balance
- Recognition and rewards for professional expertise
- Competitive, comprehensive benefit plans offered (including health, disability, vacation, sick leave, and 403B retirement plan)
- 100% Free Tuition for employees and children dependents
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
- Required Skills
Bachelor of Science Nursing required, Master’s degree preferred
3-5 years utilization review, discharge planning, and/or case management
1 -2 years prior supervisory experience.
Active and unencumbered RN License in the District of Columbia, required
Case Management Certification (CCM) Preferred.