MANAGER – UTILIZATION REVIEW & DENIALS
Froedtert
Discover. Achieve. Succeed. #BeHere
Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.
This job is HYBRID.
FTE: 1.000000
Shift: Shift 1
Job Summary:
Provides support to the Director by overseeing the day-to-day operational activities of Utilization Review and Denials Management. In collaboration with physician advisors, applies principles of leadership and human relations in the overall supervision of clinical and non-clinical personnel and program. Maintains standards in accordance with state, federal, and national standards for accurate coding. Participates in the design, implementation and evaluation of orientation, staff development, and continuing education relevant to staff. Provides oversight and direction to staff. Develops, analyzes, and monitors metrics for UR and Denial Management initiatives. Assists in budget development and maintenance. Develops and maintains working relationships with hospital departments and outside agencies to coordinate transitions through the care continuum.
EXPERIENCE REQUIRED:
A minimum of five years of experience in a hospital clinical setting, with at least three years of experience in either utilization review or denials management is required. Three years of leadership experience in a hospital setting is preferred.
EDUCATION REQUIRED:
Bachelor’s Degree in Nursing required. Graduate degree in Nursing or a related field preferred.
TRAINING PREFERRED:
Experience with use of MCG and IQ.
SPECIAL SKILLS REQUIRED:
Requires excellent observation, verbal and written communication skills, analytical thinking, and problem-solving skills. Requires strong interpersonal skills including ability to communicate well with others.
LICENSURE REQUIRED:
Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).
Perks & Benefits at Froedtert Health
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
- Paid time off
- Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
- Academic Partnership with the Medical College of Wisconsin
- Referral bonuses
- Retirement plan – 403b
- Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
- Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available
The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin’s only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.
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