Introduction

Do you have the career opportunities as a(an) Utilization Review Services Manager you want with your current employer? We have an exciting opportunity for you to join Work from Home which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Utilization Review Services Manager where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

This position will provide front-line support and supervision to the Utilization Review staff to focus on initial and continued stay authorizations and concurrent denial mitigation to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. The URS Manager will be the first point of contact for issues from the URS staff.

• Leadership – guides the department toward desired outcomes, setting high-performance standards and delivering quality services. Communicates professionally, clearly, and assertively. Strong organizational skills and ability to proactively prioritize needs and effectively manage resources. Demonstrates ability to foster a team-building environment. Excellent written and oral communication skills. Excellent interpersonal skills. Ability to work independently with little to no supervision.
• Excellent personal computer skills (MS Outlook, MS Office, Midas, EMR, OnBase, and other related software).
• Schedule flexible as per UR department needs, some weekend and or holiday work may be required.
• Work with the URS Operations Director on the day-to-day activities of the URS department staff, including but not limited to Kronos, denial mitigation, authorization procurement, daily assignments, scheduling, assisting with annual evaluations, and intervening when needed.
• Supervise and evaluate the work of the staff, including leads if applicable, and provide real-time monitoring, advisement, and education to URS staff following the HCA guidelines.
• Monitor established reports for all days authorized, accounts requiring follow-up, and productivity for staff and escalate issues and trends to URS Leadership.
• Providing ongoing education and mentoring staff
• Analyze and monitor quality and utilization trends, identify problem areas, develop strategies and recommend action plans for resolution as per HCA UR standards
• Demonstrate knowledge and effective use of multiple applications, systems, and resources example, but not limited to Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and OnBase
• Demonstrate knowledge and effective use of multiple applications, systems, and resources
• example, but not limited to Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and OnBase
• Support URS staff as needed or requested
• Ensure staff adhere to WFH policy

Education and Experience

• Bachelor's degree in nursing or equivalent experience required
• Strong clinical background with 4-6 years of nursing experience required
• 2 – 4 years of relevant case management/utilization review experience required
• Registered Nurse - Currently licensed as a registered professional nurse in the state in which he or she resides and practices, in accordance with law and regulation required
• Multi-state nursing licensure for compact states required
• InterQual Certification- IQCI or CER preferred
• 2+ years of experience in InterQual preferred

HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Utilization Review Services Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.