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MercyOne · 18 hours ago

Utilization Management Team Lead

Des Moines, IA

Full-time

Onsite

Senior Level

5+ years exp

MercyOne is a healthcare organization dedicated to providing compassionate care. The UM Lead is responsible for overseeing daily activities within the Utilization Management department and ensuring effective leadership and delegation of tasks, while also collaborating with multidisciplinary teams and managing payer interactions.

Health CareHealth DiagnosticsHospitalMedicalNon ProfitPersonal HealthPrimary and Urgent Care

Responsibilities

Facilitates daily activities of the UM department and provides leadership to the team

Assists the Director in hiring, training, coaching, and evaluating personnel

Maintains confidentiality regarding personnel matters within the department

Works with healthcare providers to assess medical necessity and appropriateness of inpatient admissions, providing feedback on documentation to support these decisions

Collaborates with the team to maximize financial reimbursement for MercyOne Central Hospital through accurate and timely clinical documentation

Coordinates with the Pre-service Team to ensure pre-certification for patients with complex diagnoses or care settings, in accordance with payer requirements

Maintains strong relationships with insurance payers to facilitate authorization approvals

Collaborates with the Revenue Cycle, HIM, Denials, and Finance teams

Recognized as an expert in UM practices and technical skills

Demonstrates effective communication (verbal, written, and digital) in various forms including medical records, emails, and phone calls

Consults with other professionals to improve patient outcomes

Utilizes current literature to guide practices and improve outcomes

Seeks assistance in conflict resolution when needed

Effectively delegates tasks to other UM team members and evaluates their performance

Completes assigned learning materials and competency activities within orientation and beyond

Contributes to the professional growth of others by serving as a preceptor, coach, and mentor

Assists in managing resources to meet quality and financial goals

Performs other duties as assigned by the manager

Maintains knowledge of relevant federal, state, and local regulations, as well as Trinity Health’s Organizational Integrity Program, Standards of Conduct, and other policies to ensure adherence

Qualification

Utilization ManagementRegistered Nurse LicenseHealthcare AdministrationLeadership ExperienceCommunication SkillsMentoring SkillsConflict ResolutionTeam CollaborationIntegrity

Required

Comprehensive knowledge of Utilization Management, typically gained through a bachelor's degree in Nursing, Healthcare Administration, or a related field, or equivalent relevant UM work experience

A minimum of 5 years of Utilization Management experience

Current Registered Nurse License in the State of Iowa required

Comfortable working in a collaborative, shared leadership environment

Strong personal presence characterized by honesty, integrity, and a caring attitude, with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health