A fantastic career opportunity for Nurse Manager of Care Management and Utilization Review is now available with a prestigious healthcare system in beautiful, serene and coastal Oregon!
The Nurse Manager of Care Management and Utilization Review will join a full-service, non-profit community hospital, offering comprehensive medical, surgical and therapeutic services. With over 300 beds, more than 2100 employees and a world-class medical staff, the hospital provides innovative, technologically advanced care on a patient-friendly, easy-access campus in the Greater Portland area.
The hospital is very proud of the acclaim they receive for excellence in patient care and safety. They accomplished Excellence Award for Stroke Care and ranked in the top 10 percent in the nation for spine surgery. They also won the Health Grades Distinguished Hospital Award for Patient Safety for the last three years in a row making them one of the safest places to get care – among the top 5% in the country.
The Nurse Manager of Care Management and Utilization Review will manage the operations and support team within Health Care Services including the Call Center, Utilization Management or Care Management intake & review functions which includes but is not limited to prior authorization, concurrent review (CCR), Claims, skilled nursing facility (SNF) Review and care management services.
The Nurse Manager of Care Management and Utilization Review will provide oversight and direction for systems and tools used internally by staff and externally by provider partners to assist in Medical or Care Management operations. The Nurse Manager of Care Management and Utilization Review will achieve organizational performance standards for Call Center activities, prior authorization, CCR review, SNF review, Claims Audit, Care Management and other areas as deemed appropriate.
The Nurse Manager of Care Management and Utilization Review will prepare and manage budget for applicable areas. The Nurse Manager of Care Management and Utilization Review will manage coordination of all work, quality improvement activities, projects, objectives and staffing of the department by working with other Managers and Supervisors within Health Care Services. Experience with HEDIS, CAHPS, Medicare 5-Star Rating, NCQA and/or URAC accreditation is ideal.
The Nurse Manager of Care Coordination and Utilization Review will have a family of healthcare professionals who not only enjoys outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty. As an employee, you will enjoy generous benefits and work/life programs. Join the reputable team now!