Utilization Review RN Manager

Job Title: Utilization Review Rn Manager

Job Description:


Auburn Community Hospital (ACH) seeks a motivated, experienced individual to join the Care
Transitions Team as a Utilization Review (UR) Registered Nurse (RN) Manager. The UR RN
Manager monitors the department’s daily activities and utilization management functions. The
UR RN Manager maintains knowledge of CMS Conditions of Participation for Utilization
Review and functions as a resource for the Care Transitions RN team on issues involving
appropriateness of admission and level of care determinations. The UR RN Manager supports the
UR Committee in preparing/presenting data and documents as indicated. The UR RN Manager
can multitask in multiple software systems, facilitate peer-to-peer discussions, generating
technical and medical necessity denials and appeals as indicated per payer requirements. The UR
RN Manager aims to balance the quality of patient care with cost efficiency, ultimately
maximizing the continuity of care a patient receives while preventing and managing denials. The
UR RN Manager collaborates with Emergency Department providers, Hospitalists, provider
offices, surgical scheduling, and any applicable departments to ensure medical necessity and
guide network partners and affiliates


Job Requirements:

• Graduation from an accredited nursing program. BSN in nursing preferred.
• Minimum 3-5 years of experience in an acute care hospital setting or equivalent health
care experience in UR.
• Prior Utilization Review/Case Management or Healthcare leadership is preferred.
• Ability to multitask between several software programs.
• Knowledge of federal, state, and accreditation standards.
• Strong technological, written, and verbal communication, organization, critical thinking,
and problem-solving skills are required.
• Perform required data entry into EMR and alternate data management systems.
• Current unrestricted NY state RN licensure.
• Ability to stand, sit, or ambulate for long periods.

Salary- $90,000-95,000 Based on experience

Full time, day shift, 37.5 hrs/wk. Potential for some weekends as required for managerial duties

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