Mgr Utilization Review RN in Trenton, New Jersey

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what’s right with a joyful heart.

• We never settle by constantly striving for better.

• We are in it together by supporting one another and those we serve.

• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our competitive benefits package empowers you to live well and provides:

• Eligibility on day 1 for all benefits

• Dollar-for-dollar 401(k) match, up to 5%

• Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more

• Immediate access to time off benefits

At Baylor Scott & White Health, your well-being is our top priority.

Note: Benefits may vary based on position type and/or level

Job Summary

As a Manager for Utilization Review, you guide and supervise staff. You oversee care coordination across all business areas. You help manage patients and speed up care transitions. You assess programs and improve them. You evaluate workflow and system design to meet requirements.

Essential Functions of the Role

• Manage Care Coordination operations daily, including supervision of staff, resource management, and budget control. Departments involved are Utilization Management, Case Management, and Disease Management.

• Ensure all regulations, policies and procedures of the division are strictly adhered to during daily operations.

• Partner with both internal and external teams to guarantee top-notch service for all stakeholders, including members and providers.

• Develop a comprehensive knowledge of the medical management system, which involves in-depth understanding of the system configuration.

• Assess system changes’ impact, configure as needed, document changes carefully, and track changes to meet requirements.

• Continuously improve policies, procedures, resources.

• Regularly audit and train to meet business goals effectively.

• Partner with teams for good care, lower costs. Move patients quickly through care levels for better outcomes.

• Manage continuing care for all members, focusing on case management for specific populations and members.

Key Success Factors

• Demonstrable knowledge in discharge planning, case management, utilization review and different care levels.

• Outstanding written and verbal communication skills, which are maintained professionally in all interactions.

• An expertise of healthcare systems and healthcare plans.

• Capability to adjust to changes in the medical management system and assess their impact in meeting regulatory and business requirements.

• Skills in operational decision-making about work processes including quality and productivity standards, setting clear goals for employees and project teams.

• Ability to align resource allocation recommendations with broader goals for effective scheduling and goal realization.

• Proficiency in making effective recruitment and termination recommendations.

• Capacity to evaluate and propose changes to policies and implement procedures that influence the managed organization.

• Understanding business operations involves planning, goal setting, budgeting, employee compensation, risk management, and compliance activities.

• Familiarity with general computer applications like Microsoft Office, information security software, scheduling and payroll systems, email, and electronic medical documentation.

Belonging Statement

We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

Qualifications

• Possess a Bachelor’s degree

• Have at least five years of relevant work experience

• Hold a valid registration as a Registered Nurse

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.