Utilization Management Manager - Denial Appeals and Audit

You Belong Here.

At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and flexible schedules. We are connected by our mission - partnering and healing for a healthy future - and dedicated to the health and well-being of the communities we serve.

FTE: 1.0, Shift: Day, Schedule: Monday-Friday, weekends vary, Exempt

Position Summary

The Manager of Utilization Management (UM) manages the day-to-day operations of the Utilization Management Program system-wide to accomplish all established goals within the provisions of MHS policies and standards and federal, state and local regulations. The Manager works closely with Medical Advisors and Physician Leaders/Executives to resolve issues of medical necessity; ensures cost effective and quality patient care by managing appropriate utilization of resources; provides direction and guidance to staff, setting/monitoring productivity and quality standards; serves as the utilization management resource/expert; manages the denial/appeal process and consistently models teamwork and collaboration competencies. Hospital-based leaders may have a dual matrixed reporting structure.

Requirements

• BSN or bachelor's degree in health care related field required
• Current license as a Registered Nurse license in Washington State or Multistate License endorsement (MLS)
• Specialty certification preferred
• Five (5) years of experience in nursing roles including duties aligned with utilization management and discharge planning
• Three (3) years of experience in a supervisory or lead capacity

Our Values

As a MultiCare employee, we'll rely on you to reflect our core values of Respect, Integrity, Stewardship, Excellence, Collaboration and Kindness. Our values serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.

Why MultiCare?

• Belonging: We work to create a true sense of belonging for all our employees
• Mission-driven: We are dedicated to our mission of partnering for healing and a healthy future and the patients and communities we serve
• Market leadership: Washington state's largest community-based, locally governed health system
• Employee-centric: Named Forbes “America’s Best Employers by State” for several years running
• Technology: "Most Wired" health care system 15 years in a row
• Leading research: MultiCare Institute for Research & Innovation, 40 years of ground-breaking, clinical and health services research in our communities
• Lifestyle: Live and work in the Pacific Northwest - offering breathtaking water, mountains and forest at every turn

Pay and Benefit Expectations

We provide a comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off. As required by various pay transparency laws, we share a competitive range of compensation for candidates hired into each position. The pay scale is $168,834.00 - $234,395.00 USD. However, pay is influenced by factors specific to applicants, including but not limited to: skill set, level of experience, and certification(s) and/or education. If this position is associated with a union contract, pay will be reflective of the appropriate step on the pay scale to which the applicant’s years of experience align.

Associated benefit information can be viewed here.

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