UM Manager

Job Description: * Job Description: The Utilization Manager manages the activities of the Resource Center including the UM Coordinators. The Utilization Manager acts as a resource / mentor for Case Managers, Social Workers and other institutional personnel, and participates in the development and implementation of new institutional initiatives. This individual assist the Director of Case Management in providing ongoing education to Case Managers, UM Coordinators, and other hospital personnel as needed. The UM Manager collaborates with Appeals Management, Managed Care Contracting and other Institutional departments to ensure contractual compliance and optimal reimbursement by Third Party Payors. Liaises with external agencies to maintain and optimize delivery of quality of care throughout The industry.Job Qualifications: Job Qualifications: Principal Duties and Responsibilities: - Responsible for UR/Managed Care components of Case Management.- Responsible for the direct supervision of the Utilization Management Coordinators.- Work with Case Managers on readmissions and ensure compliance with policy- Manage combined stay bucket in finance's Trac system.- Attend interdisciplinary rounds on assigned units.- Meet with Case Managers, as assigned to review medically complex and long stay cases; refer to physician advisor as indicated.- Collaborates with Social Work Supervisors to resolve discharge planning issues on assigned units.- Run a daily report on avoidable days and follow up with Case Managers on accuracy and completeness of avoidable days.- Review medical records and provide retro reviews to managed care companies as needed.- Collaborates with relevant institutional personnel to ensure that contractual obligations to Third Party Payors are met.- In the Director of Case Management's absence, authorize planned time off.- Provide coverage schedule for Case Managers and Utilization Management Coordinators for planned and unplanned time off.- Maintain and implement primary / secondary coverage schedules.- In collaboration with Director of Case Management, implement disciplinary action for attendance issues.- Collaborates with the Director of Case Management to develop, implement and maintain Core Department standards of practice and ongoing education for Case Managers.- Acts as a resource to Case Management and nursing staff re: current institutional, regulatory and Third Party Payor requirements.- Assists Director of Case Management in recruitment and hiring of new personnel and participates in their orientation.- Oversees and maintains Outside Agency Sign-in Protocol in compliance with HIPAA regulations.- Manages Third Party Payor On-Site programs.- Meets as necessary with Third Party Payors and Managed Care Contracting to maintain optimal collaboration and appropriate reimbursement.- Works with Finance to manage High Risk cases to optimize reimbursement. Knowledge, Skills and Abilities Required: 1. Licensure and current registration as Registered Nurse in New York State.2. BSN preferred3. 3-5 years clinical experience4. Experience in UR/UM/QA required5. Excellent communication skills 6. Working knowledge of data management