Job Description​

The Manager of Utilization Review is responsible for overall policy and operational accountability for utilization review to meet system strategic goals and directions. This position oversees utilization for all patient encounters. This includes management of the department budget, hiring and performance management. The manager is responsible for supporting the educational and training needs of staff with day-to-day operations and supervision, as well as assisting the System Director with strategic planning and implementation of newly revised processes. Requires an active participation in process improvement, JCAHO preparedness, payor collaboration and other hospital committees. The Manager of Utilization Review works closely with each entity and system leadership.

Experience: Managerial experience in utilization review in hospital setting. Experience with implementing and overseeing a utilization review program. Extensive knowledge of reimbursement mechanisms, denial prevention and clinical utilization management. Working knowledge of state and federal government regulations such as RAC/MAC, 2 Midnight Rule, readmissions, efficiency of care across the continuum and accountable care organization models. Requirements include BSN in Nursing, Registered Nurse Missouri and Kansas License and 3-5 years experience in Utilization Review.

Job Requirements

Applicable Experience:

3-5 years

Bachelor's Degree - Nursing, Master's Degree - Health Administration

Job Details

Full Time

Day (United States of America)

The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.