Report to the Associate Director of Care Management
Use clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determinations
Operate within established guidelines and use advanced technical expertise to address moderately complex issues
Determine methods, resources, schedules, and goals based on assigned goals
Responsible for leadership and oversight of the physical health Utilization Management staff in daily operations
Hire, coach, counsel and evaluate performance of direct reports
Implement and maintain processes compliant with MDHHS and NCQA guidelines
Work with UM leadership to reduce inefficiencies and provide solutions to improve clinical outcomes
Collect and analyze data to guide operational metrics and associate performance
Coordinate and communicate with Providers, Members, or other parties to facilitate care and treatment
Facilitate cross-departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across departments.

Bachelor's Degree
2 or more years of management experience
Licensed Registered Nurse (RN) in Michigan with no disciplinary action
Previous experience in utilization management
1+ years experience within long-term services and supports (LTSS) programs, including knowledge of Medicaid waivers, care coordination, and eligibility requirements
Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Demonstrated ability to work independently under general instructions and collaboratively within interdisciplinary care teams, including social workers, nurses, and allied health professionals.

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
short-term and long-term disability
life insurance

LTSS UM Nurse Manager

Key skills