Job Details

Responsible for Inpatient Utilization Management function for Riverside Health System's Acute Care Hospitals. Responsible for overall policy and operational accountability for utilization review to meet system strategic goals and directions. Oversees team members with responsibility for all utilization review activities including monitoring all admissions, concurrent, retrospective and denial reviews, and communicating the patient's plan of care to insurance companies. Partners with Physician Advisor staff as indicated and is responsible for all UM Committee Meetings. Maintains accuracy to track all claims, runs productivity reports, and ensures the timely entry of information related to coordination of reviews in all appropriate systems. Develops and revises policies and procedures, monitors performance, coaches and counsels staff. Participates in process improvement, survey preparedness, insurer collaboration and system/hospital committees. What you will do. Provides direct oversight...Management, Director, Leadership, Case Manager, Healthcare, Health