Utilization Management, Manager (RN) - Dartmouth-Hitchcock Health

The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health system hospitals covering a range of settings from the Academic Medical Center to Critical Access Hospitals.   This role involves collaborating with program medical directors, care teams and health plans to ensure regulatory compliance and appropriate financial outcomes.  Identifies opportunities and takes a leadership role in departmental performance improvement activities.  Applicants should have strong communication and analytical skills. Experience with Epic and medical necessity denials is preferred.

This position has the option to be Fully Remote!

These are just a few highlights of being a nurse at Dartmouth Hitchcock Medical Center and Clinics in New Hampshire.

• We have loan repayment up to $20,000.
• We offer Relocation Assistance and a Housing Coordinator to take on the burden of finding a home.
• We offer generous tuition reimbursement.
• We have a very popular "earned time" plan.
• We have extensive CEU/Training programs.
• Our 8,000 ft Patient Safety and Training Simulation Center is state-of-the-art.
• Our nurses serve as central figures in the success of our system through our shared governance nursing model.
• We offer a rigorous, research-focused environment.
• Dartmouth Hitchcock's Nursing Continuing Education Council is accredited as a provider of continuing nursing. education by the American Nurses Credentialing Center.

Why are we so unique? We are a nationally recognized Academic Medical Center set right in the middle of the White Mountains of New Hampshire. We recognize that “quality of life” means different things to different people, but we are very confident you will love it here as we have beautiful, rural and suburban housing options, world-class primary, secondary, and graduate schools, hundreds of lakes, thousands of miles of hiking trails and some of the best skiing in the country. This all means you can be a happy nurse with more quality time with friends, family, pets or maybe just quiet hikes by yourself. Our idea of traffic in the “Upper Valley” of New Hampshire is a line on the ski mountain at the chair lift.

Read more about Dartmouth Health and why YOU should work here.

The Dartmouth Health system stretches over New Hampshire and Vermont and offers the quintessential New England experience. With no income or sales tax, this beautiful area combines history, industry, and business and has been ranked consistently as one of the best places in the US to live and work. Anchored by the academic Dartmouth Hitchcock Medical Center in Lebanon, NH, the system includes the NCI-designated Dartmouth Cancer Center, Dartmouth Health Children’s; 4 member hospitals, and 30 Dartmouth Hitchcock ambulatory clinics across the region. With destinations like Boston, New York, the seacoast, and ski country within driving distance, the opportunities - both career and personal - truly make New Hampshire the ideal place to work and play.

Applicants are encouraged to visit our nursing career site to learn more and apply:

Please visit:  https://dhnursing.org/nursing-careers/

Dartmouth Health is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, veteran status, gender identity or expression, or any other characteristic protected by law.

1. Supervises assigned personnel. Selects, counsels, prepares performance evaluations, and terminates according to policy.
2. Oversees workflow related to patient status determinations.
3. Identifies clinical areas that require intervention and education, works closely with Epic teams to evaluate decision support and documentation solutions.
4. Coordinates with physician offices and outside revenue cycle vendor on pre-certifications related to patient status.
5. Assumes responsibility for the oversight of in bed denials, including, but not limited to, reviewing denial letters, collaborating with clinicians and Health Plans.
6. Develops and implements communication strategies to keep clinicians and staff informed of changes and current practice.
7. Report on key metrics for program including; length of stay, readmission rates, prior approval/pre-certifications and denials.
8. Provides information to departmental leadership that reflects trends and practices that may need organization, intervention, and change.
9. Collaborates with medical directors, peers and vendor on new or revised Health Plan contracts and changes in governmental reimbursement.
10. Collaborates with Care Managers and Transfer Center regarding medical necessity, authorizations and delivery of notices.
11. Benchmarks with other facilities concerning admission and denial experience and policies.
12. Performs other duties as required or assigned.

• BSN with 3 years of clinical experience required.
• MSN preferred.
• Strong leadership, communication and computer skills desired.

• Licensed Registered Nurse with NH eligibility
• BLS certification required.