RN Manager of Utilization Management

At North Memorial Health, you’re part of an inclusive health team that is rooted in our values: Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North’s culture which is designed to actively support each team member’s wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health.

Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women’s Choice Award Best Hospitals list.

At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.

About this position

The Utilization Management Manager helps develop and advance the strategic and tactical utilization review goals of NMH. The Manager manages the NMH System Utilization Management program and staff, including services provided at North Memorial Health Hospital and Maple Grove Hospital. The Utilization Management program includes processes for determining insurance authorization, medical necessity, patient status management and payor denials/appeals for medical necessity.

Requirements

• Four-year nursing degree required.   

• Registered Nurse with a minimum of 4 years clinical experience in an acute hospital setting required.
• Minimum of 5 years of utilization management experience required.

• Familiar with State and Federal standards/requirements.
• Knowledgeable about third party payer source criteria for medical necessity.
• Organized and able to meet deadlines consistently.
• Experienced in team and collaborative approaches to management. Ability to work with various individuals across the organization to facilitate change and build interdepartmental cooperation.
• Excellent written and verbal communication skills.  

The North Memorial Health System is dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role, but your past experience doesn’t perfectly align with every qualification listed, we encourage you to apply anyway. You may still be the right candidate for this or other roles.

Work Group: Non Contract

Hours per two week pay period: 80

Shift: Days 8 hours    

Weekend Requirement: None

Call Requirement: None

Remote or On-site: Hybrid Remote- Must live in MN or WI 

FLSA Status: Exempt

Benefit Eligibility: Health insurance benefits are available for this position. North Memorial Health offers multiple health plans based on work group eligibility.

Salary Range: L12 ($52.46 - $81.30), based on experience  

Shift Differential: Compensation may include shift differential pay depending on the position and shift worked.

STI Bonus Eligible: True 15%

Employment Sponsorship: Applicants must be currently authorized to work in the United States on a full-time basis. Work visa sponsorship is not available for this position