Manager Utilization Review

Novant Health Charlotte, North Carolina
manager utilization utilization review team utilization utilization review team member health management healthcare leadership mckesson procedures
September 24, 2022
Novant Health
Charlotte, North Carolina
Overview

The Manager of Utilization Review is responsible for oversight and management, operations and ongoing quality, productivity and efficiency for utilization review processes. Responsible for maintaining appropriate compliance with government payer regulations and commercial payer requirements as it relates to initial, concurrent and retrospective medical necessity reviews through timely, efficient and accurate processes.

At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.

Qualifications
  • Education: Bachelor's Degree Required. BSN Required. Master's Degree Preferred.
  • Experience: Minimum three years clinical experience in a hospital or related healthcare environment, required. Three years experience in Utilization Review or related experience. Leadership experience, and McKesson Interqual Experience, preferred.
  • Licensure/Certification/Registration: Current RN licensure in appropriate state, required. UR certification or Interqual Certified Instructor, preferred.
  • Additional Skills/Requirements (required): Current and future trends/practice in area of responsibility; regulatory and governing standards, policies and procedures; information systems and software used in area of responsibility; equipment used in performing assigned duties; application of safety and infection control policies and procedures; skills in interviewing and selection process; understanding of budgeting, staffing, payroll and purchasing processes; implementation of competency, feedback, development and progressive discipline processes; teambuilding; conflict management, and interpersonal relationship skills; principles of adult learning and teaching methods/models; decision making, project leadership and consultation; delegation and communication skills; understanding of customer needs and expectations and knowledge for improvement to exceed customer expectations. Develops and continuously improves utilization review core processes.
  • Additional Skills/Requirements (preferred): Knowledge/Competence of Microsoft office products and keyboarding McKesson Interqual criteria.
Responsibilities

It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time.
  • Our team members are part of an environment that fosters team work, team member engagement and community involvement.
  • The successful team member has a commitment to leveraging diversity and inclusion in support of quality care.
  • All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm".

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