Manager, Utilization Review

Overview

To provide leadership to integrated inpatient teams; assists Director in the management of the department; including personnel and fiscal management and development of and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing Inter Qual and/or MCG screening guidelines, and clinical denials/appeals oversight.

Participates in department and hospital performance improvement activities; responsible for outcomes reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence‑based and outcome‑focused family centered care management and services.

At Children's Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, teamwork and integrity.

Additionally, it is important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as Children’s Mercy staff, we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non‑immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005.

If you are selected for this position, you will be asked to supply your immunization records as proof of vaccination. If you have concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

• Personnel management
• Participates in department and organization performance improvement activities
• Department management and program development
• Assists the department Director with fiscal management and accountability

• Bachelor's Degree in nursing
• 3‑5 years experience in Utilization Review
• Master's Degree in nursing (required within 4 years of hire)
• 1‑2 years experience in Utilization Review
• Licensed RN – Missouri (MO) or Kansas (KS) required upon hire
• RN Compact license for all states besides KS and MO (must obtain KS or MO Compact within 60 days of hire)
• American Case Management or Certified Case Manager required upon hire (must obtain within 730 days)
• Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications required upon hire

The benefits plans at Children’s Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families.

Our pay ranges are market competitive. The pay range for this job begins at $43.95/hr, but your offer will be determined based on your education and experience.

This position is not eligible to work remotely, which means that the person hired will be required to work onsite at one of our Children’s Mercy locations and may not work from home.

Children's Mercy hires individuals based on their job skills, expertise and ability to maintain professional relationships with fellow employees, patients, parents and visitors. A personal interview, formal education and training, previous work experience, references and a criminal background investigation are all factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry or veteran status.

A drug screen will be performed upon hire. Children's Mercy is smoke and tobacco free. CM is committed to creating a workforce that supports the diverse backgrounds of our patients and families. We know that our greatest strengths come from the people who make up our team, so we hire great people from a wide variety of backgrounds, not just because it’s the right thing to do, but because it makes our hospital stronger and our patient care more compassionate.