RN- Utilization Review Director for WI
- Milwaukee, WI
- Permanent
- Full-time
- Department: Utilization Management
- Schedule: Full Time, Partially Remote
- Hospital: Multiple Ascension Hospitals in WI
- Location: Milwaukee, WI
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your communityBenefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.ResponsibilitiesProvide strategic direction and oversight of the day-to-day operation of utilization management function within the insurance plan.
- Ensure integration of utilization management functions with network strategy and claims processing.
- Oversee work with provider relations on resolving issues.
- Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
- Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.
- Oversee implementation and maintenance of prior authorization codes for all clients.
- Registered Nurse obtained prior to hire date or job transfer date required.
- Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.
- Master's degree or combination of Bachelor's degree and experience preferred.
- 5 years of experience required.
- 10 years of experience preferred.
- 2 years of leadership or management experience required.
- 5 years of leadership or management experience preferred.