RN Mgr, Utilization Management - Post Acute

apartment Summa Health location_onCleveland, OH, US

$41.15 - $61.72 / HOUR

RN Manager, Utilization Management - Post Acute

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid after training - 1 Day a week onsite / occasional site visits w/in area

We are seeking an experienced (RN) Nurse Manager to lead our post-acute Utilization Management Team in applying InterQual criteria for precertification/authorization. Previous hospital and/or health plan experience with Discharge Planning desired, and knowledge of post-acute admission criteria (SNF, AR, LTAC). This role would be a hybrid position once acclimated, with one day a week onsite with occasional site visits within the area.

Summary

Perform duties to conduct and manage the day-to-day operations of the utilization management function for post-acute utilization services. Communicate with staff to facilitate daily department functions including prior authorization for post-acute services related to Long Term Acute Care Hospital (LTACH), Acute Rehabilitation (AR), and Skilled Nursing Facilities (SNF), Discharge Planning and transitions of care. Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs. Meets organizational, operational and service goals related to quality outcomes, member experience, and cost-efficiency.

Formal Education Required

Bachelor’s degree or equivalent combination of education and/or experience
Licensed as a Registered Nurse in the state of Ohio
Case Management Certification (CCM, ACM) preferred

Experience And Training Required

Three (3) years performing post-acute utilization management/ discharge planning activities and minimum of four years relevant clinical experience.
Experience including prior authorizations, post -acute clinical nursing, health plan management, working knowledge of Medicare and/or Commercial plan designs, and/or experience with clinical regulatory and accrediting guidelines preferred
Prior management/leadership experience required, preferably in post-acute areas and/utilization management, or health plan management.
Knowledge of clinical authorization criteria required. Knowledge of InterQual or MCG preferred. Must be knowledgeable of CMS post-acute admission requirement.
Moderate computer skills and familiarity with Outlook, Word, Excel, PowerPoint required. Able to interpret data reports.
Knowledge of Epic preferred

Other Skills, Competencies And Qualifications

Flexible: Ability to adapt to meet business needs.
Access to own vehicle for occasional travel to area post-acute facilities.
Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

Level Of Physical Demands

Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.

As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Equal Opportunity Employer/Veterans/Disabled

$41.15/hr - $61.72/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short-Term and Long-Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay

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