Utilization Review Senior Manager

Banner Health Phoenix, AZ
Offers a remote, work from home position!

Candidates must live within the Phoenix vicinity.

Banner Health believes leadership matters, and we look for people who share our vision making health care easier, so life can be better. Our leaders are at the front of the health care transformation, planning the future of Banner Health.

Banner Health is currently seeking a Utilization Review Sr. Manager to join the Medical Management Department.

The Medical Management Department is responsible for execution on strategies that support right setting, right service and right cost for Banner Health populations employing tactics such as prior authorization and utilization review to influence member and provider behaviors.

As a Utilization Review Sr. Manager, you would be responsible for the division that handles concurrent denials issued to Banner Health by various insurances. You will oversee a diverse team of direct reports that work both remote and on campus with a focus is denial management.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

About Banner Health Corporate

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

About Banner Health

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

Job Summary

This position plans and provides managerial and/or clinical support to patients, staff and leadership within the department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes related to delivery of Case Management services.

Essential Functions

* Provides and/or facilitates case management and/or other related activities and serves as a resource to other staff members. Promotes interdisciplinary patient care planning and supports Care Model.

* Hires, trains, conducts performance evaluations, and directs the workflow for the staff. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.

* Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes. Acts as a consultant within the organization and perhaps in the community.

* Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities within the department. Works with staff to make necessary changes. May analyze data and healthcare trends to gain efficiencies and improve patient outcomes.

* Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.

* Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.

Minimum Qualifications

BSN or MSN required for all new hires to the position after October 1, 2016. Incumbents in the position as of October 1, 2016 must possess their by BSN or MSN July 1, 2018.

Requires current Registered Nurse (R.N.) license in state worked.

Requires extensive knowledge in the areas of case management and utilization management. Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources. Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. In BPA (Benefits Plan Administration) setting, requires an understanding of reimbursement methodologies.

Preferred Qualifications

Additional related education and/or experience preferred.