Manager, Utilization Management

The Opportunity

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.

Position SummaryHuron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Munson Healthcare revenue cycle operations are jointly operated by Huron and Munson Healthcare. Huron provides strategic revenue cycle operations leaders (managers and above are employed by Huron), while revenue cycle associates and supervisors are badged and employed by Munson Healthcare. Munson Healthcare, like all other providers in the market, is under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Munson, in collaboration with Huron, must empower leaders, clinicians, employees, affiliates, and communities to build a culture that fosters innovation to achieve the best outcomes for patients and succeed long-term.
Learn more about Munson Healthcare here: https://www.munsonhealthcare.org/.
Joining the Huron Managed Services team means you’ll help Munson Healthcare evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.Qualifications

The Utilization Management Specialist is responsible for ensuring the appropriate utilization of healthcare services by reviewing patient cases for medical necessity, appropriateness, and efficiency of Munson Healthcare's services. This role involves collaborating with Munson Healthcare's providers, patients, and insurance companies to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and organizational policies.

Key Responsibilities:

• Manage the process of conducting pre-authorization, concurrent, and retrospective reviews of healthcare services for medical necessity and appropriateness
• Evaluate clinical information to determine the necessity of hospital admissions, treatments, and procedures based on established criteria and guidelines.
• Maintain accurate and detailed records of review decisions and interactions in the utilization management system.
• Generate and analyze reports on utilization trends, denials, and appeals to identify areas for improvement.
• Ensure compliance with federal, state, and local regulations, as well as accreditation standards.
• Participate in quality assurance activities to improve utilization management processes and patient care outcomes.
• Lead UM Denials Team Meetings to address denial management strategies.
• Manage Budgeting and Staffing to ensure adequate resources and efficient operations.
• Engage in Strategic Planning with Physician Advisors and PCM Leadership for long-term goals.
• Conduct Outreach to Functional Leaders to ensure alignment and support for denial prevention initiatives.
• Conduct Long Length of Stay (LLOS) Reviews to manage patient flow and mitigate unnecessary hospital stays.
• Attend MMC and MHC Monthly Leadership Meetings to stay informed on organizational goals and updates.
• Participate in MMC Daily Check-Ins and conduct daily Staff Huddles for operations and priorities review.
• Lead Patient Care Management Escalation Huddles to address urgent issues.
• Facilitate Patient Status Rounds to review patient care plans.
• Optionally join OR Collaborative Huddles and Daily OR Availability Reviews for surgical coordination.
• Conduct UM Staff Training and Competency, including Interrelater Reliability Testing for IQ and MCG.
• Attend Care Management (CM) System Meetings and Improving Transitions of Care Meetings for system-wide alignment and enhanced patient handovers.
• Participate in Monthly Director Meetings, Rehab/PCM Monthly Touch Base Meetings, Munson/PH Operational Forum, and UM Contracting Workgroup for updates and collaboration.
• Contribute to MHC Workgroup and Data Prep to optimize patient throughput and analyze length of stay metrics.
• Attend Acute and Ambulatory Committee Meetings, RC Governance Meetings, and Subcommittee Meetings for denial prevention and strategic discussions.

• Hold weekly 1:1 meetings with the Senior Coordinator and conduct Staff 1:1's to provide support and guidance.
• Conduct MMC ER Social Admission Reviews and Patient Care Management Patient Access Touch Base meetings for care management coordination.
• Manage Inpatient/Outpatient Surg Website Access and Rac Monitor Website Access to ensure regulatory compliance and up-to-date information.
• Serve as a Resource for Healthcare IQ and MCG Tools and oversee UM Denials Database Management for accurate documentation
• Engage in Munson Leadership Connect (Huron) for leadership development.

The estimated salary range for this job is $80,000 - $115,000. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an individual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes and required travel. This job is also eligible to participate in Huron’s annual incentive compensation program, which reflects Huron’s pay for performance philosophy and Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.

Posting CategoryHealthcareOpportunity TypeRegularCountryUnited States of America