Utilization Management Nurse Manager, Hybrid, 40 Hours (Days)
BMC Company LLC(1 month ago)
About this role
The Nurse Manager for Utilization Review and Clinical Appeal Management oversees daily operations of the Utilization Management and Clinical Appeal teams within a hospital setting, ensuring compliance with policies, payer guidelines, and regulations. The role focuses on improving utilization review, denial management, and reimbursement processes while supporting high-quality patient care. The position also involves leadership, staff development, and collaboration with interdisciplinary teams to drive quality improvement.
Required Skills
- Leadership
- Staff Training
- Utilization Review
- Appeals Management
- Denials Management
- Compliance
- Quality Improvement
- Data Analysis
- Epic
- InterQual
+2 more
Qualifications
- Diploma In Nursing
- ASN
- BSN
- Master's Degree In Nursing
- Registered Nurse License - Massachusetts
- CCM
- ACM-RN
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