Utilization Review Manager - Home Care jobs in Missouri

Location: Columbia, Missouri - Hybrid Remote

Shift: Monday - Friday, 8am - 5pm

Department: Utilization Management

Salary Range: $79,040 - $112,986/year - final salary based on experience

ABOUT THE JOB

MU Health Care is seeking a Nurse Supervisor for Utilization Review. This position is a pivotal role calling for strong leadership and a commitment to quality care. We're looking for someone who can guide our team with confidence, ensuring smooth operations and effective communication. The ideal candidate will possess analytical skills and a knack for problem-solving, driving improvements in our utilization management processes. With excellent interpersonal skills, you'll collaborate seamlessly with healthcare professionals and payers to optimize outcomes,

streamline processes and maximize revenue cycle performance. Join us in making a difference in patient care and organizational efficiency.

ABOUT MU HEALTH CARE
MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals - including the region's only Level 1 Trauma Center and region's only Children's Hospital - and over 50 specialty clinics located throughout the region.
As an MU Health Care employee, you'll be part of an exceptional team committed to our mission of saving and improving lives. Our core values of inclusion, respect, service, discovery, responsibility and excellence foster a collaborative work environment where you can grow your career.

EMPLOYEE BENEFITS

• Health, vision and dental insurance coverage starting day one
• Generous paid leave and paid time off, including nine holidays
• Multiple retirement options, including 100% matching up to 8% and full vesting in three years
• Tuition assistance for employees (75%) and immediate family members (50%)
• Discounts on cell phone plans, rental cars, gyms, hotels and more
• See a comprehensive list of benefits .

JOB DUTIES
Oversee, coordinate, and monitor the daily operations of the Utilization Review team to meet department objectives of determination and coordination of appropriate levels of care and medical necessity, facilitating communications with the insurance company and obtaining authorization for encounters.

Act as a resource for direct reports in problem-solving difficult issues or answering questions regarding Utilization Review operations. Serve as a subject matter expert to departmental staff, internal departments, and clinical staff regarding utilization review functions and processes. Model effective communication when interacting with direct reports, providers, and clinical staff across all service lines.

Participate in the development and implementation of effective and efficient policies, protocols, processes, and reports that support and further enhance the utilization review process. Ensure alignment with regulatory and health plan requirements.

Measure and monitor key performance indicators for the department on a team and individual basis, providing feedback as appropriate. Perform root cause analysis and lead continuous improvement initiatives to enhance the effectiveness of the utilization management program. Promote team and employee engagement by participating in or leading team huddles to share information, check on the status of daily work, identify team concerns, and take countermeasures to correct or escalate issues as needed.

Assist with human resource functions for the department including assisting with selection, orientation, and mentoring of new team members. Provide coaching, counseling, and employee development for team members. Determine the need for and conduct in-service training to improve the quality of admission and continued stay reviews and to disseminate information related to changing regulatory guidance or health plans.

Collaborate with other revenue cycle departments to ensure optimal revenue cycle performance including reduction in denials and write-offs and improved collections.

Collaborate closely with physicians, clinical staff, and other departments to ensure accurate, timely, and compliant billing and reimbursement and to escalate utilization review issues as soon as possible.

Develop, coordinate, and maintain daily staffing schedules to ensure the appropriate level of unit coverage and continuity of care.

Monitor time and attendance in alignment with MU Health Care policies and practices, ensuring accuracy of records and timely submittal/approval for payroll purposes.

May complete unit/department specific duties and expectations as outlined in department documents.

KNOWLEDGE, SKILLS, & ABILITIES
Strong analytical and critical thinking skills.

Effective negotiator.

Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.

Excellent interpersonal, written, and verbal skills.

Ability to effectively communicate with a variety of individuals including physicians and payer representatives. Experience with Cerner EMR and Utilization Review admission screening criteria.

Bachelor of Science in Nursing or a related degree.

Three (3) years of RN experience.

Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.

Preferred Qualifications
Two (2) years of experience in first-level supervision of nurses, including registered nurses, or one (1) year of experience in the clinical instruction of nurses.

Two (2) years in the treatment of chronic and short-term medical and surgical inpatient problems.

Two (2) years of prior Utilization Review experience in an acute care hospital setting.

Additional license/certification requirements as determined by the hiring department.

Physical Demands
The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

Equal Opportunity Employer

The University of Missouri System is an Equal Opportunity Employer. Equal Opportunity is and shall be provided for all employees and applicants for employment on the basis of their demonstrated ability and competence without unlawful discrimination on the basis of their race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law. This policy applies to all employment decisions including, but not limited to, recruiting, hiring, training, promotions, pay practices, benefits, disciplinary actions and terminations. For more information, visit

All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law.