We are Hiring at Jewish Hospital

Location: 200 Abraham Flexner Way Louisville, KY 40202

Shift Options: Full Time, First

About UofL Health

UofL Health is a fully integrated regional academic health system with eight hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.

With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.

Under the direction of the System Director of Care Coordination, the Manager of Utilization Review performs activities which support the systems Utilization Management workflows and processes. The Manager oversees the delivery of the Utilization Management process not limited to and including making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews. Assures that staff are communicating with physicians and case managers regarding payor approval/denial of admission and continues stay review. The Manager of Utilization Management promotes optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, vision and values of University of Louisville Hospital. The Manager participates in planning, organizing, prioritizing, implementation and evaluation of activities and staff engaged in utilization management. This individual works to help ensure institutional compliance with regulatory agencies and third-party payers. Must demonstrate a working knowledge of finance, reimbursement, third party payers, community resources/agencies, accreditation standards, quality improvement, clinical care, and board base organization issues. Utilizes the management process (plan, organize, direct and control) to provide a framework for decision-making. Maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required. Must be able to adjust work hours depending upon departmental and organizational needs as determined by the director.

Education:
• Bachelor’s degree in nursing or equivalent experience. (Required)

• Master’s degree (Preferred)

Experience:
• Proficiency level typically attained with 3+ years in utilization management experience. (Required)
• Managerial experience and leadership of a Medical Management staff within a managed care or hospital environment. (Required)
• Strong background in nursing, health administration, financial and fiscal management, utilization management or care management experience in an acute care facility HMO/PPO/PRO (Preferred)

Licensure:
• Active, unrestricted RN license in the State of Kentucky. (Required)

Certification:
• BLS-CPR (Required)
• Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) (Preferred)

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