Hennepin Healthcare is seeking a Utilization Review Manager to join the Transitional Care Team. This is a full-time management role with remote capability and onsite presence as needed.
The role is responsible for managing the design, development, implementation, and monitoring of utilization review functions. The manager oversees daily operations, supervises staff performing utilization management activities, and works to achieve clinical, financial, and utilization goals through effective leadership, communication, and operational oversight.
Key responsibilities include collaborating with nursing, physicians, admissions, fiscal, legal, compliance, coding, billing, and payer partners; overseeing medical necessity screening and patient status determinations; managing payer communications and denial workflows; supporting Medicare notification letter processes; and helping improve utilization, reimbursement, and denial prevention processes.
Minimum Qualifications
- Bachelor's degree in nursing or a related field
- 3 to 5 years of leadership experience, such as charge nurse, team leader, preceptor, or committee chair
- 5 years of clinical experience
- At least 1 year of utilization review experience
- Current Registered Nurse licensure from the Minnesota Board of Nursing upon hire
Preferred Qualifications
- Master's degree
- CPHM, CCM, or ACM certification
- Experience in surgery, emergency care, and/or critical care
- Experience with process and quality improvement, quality measurement, data abstraction, data analysis and reporting, and data integrity
Skills and Abilities
- Ability to deliver financial results for assigned areas
- Knowledge of financial management, quality improvement processes, and human resources management
- Ability to monitor resources and make informed recommendations
- Strong written and verbal communication skills
- Ability to lead, delegate, analyze information, and solve problems
- Strong confidentiality, integrity, creativity, and initiative
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Short-term disability insurance
- Long-term disability insurance
- Retirement funds
- Paid time off
- Tuition reimbursement
- License and certification reimbursement for benefit-eligible positions
Location
Minneapolis, Minnesota, US
Employment Type
Full-time
Experience Level
Manager
Remote work allowed
Yes
Posted
1 month ago