Are you looking for your next healthcare job where you can be a part of a compassionate care-giving team? Are you seeking a job that is meaningful, where co-workers cooperate to ensure that our patients’ needs are met? NMC Health is proud to set an award-winning, nurse driven standard for healthcare in the Wichita Metro Area.  As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation, continuing education, constructive feedback, advancement opportunities and a comprehensive benefit plans-to take care of you and your family, now and in the future. At every turn, at every step of our journey you can build a long, successful career with NMC Health.

We are currently seeking a Utilization Management (UM) Specialist for our Case Management department.  In this role, you will be supporting the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.  You will also be responsible for performing a variety of concurrent and retrospective UN-related reviews and functions and ensuring that appropriate data is tracked, evaluated and reported.  Furthermore, you will be responsible for monitoring the effectiveness/outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences and/or stakeholders and designing and implementing process improvement projects as needed.  Additionally, you will also be responsible for identifying, developing, and providing orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis.  Lastly, you will be responsible for ensuring that the UM program maintains documented, and up-to-date policies and procedures and ensuring that all UM key processes have valid outcome measures that are monitored for compliance and for reporting to a variety of stakeholders/audiences.  If you feel that you would love to be considered for this role we invite you to become a part of a positive, upbeat work environment where you can expect to be heard, where you are positioned as a valued professional on the team, where we allow for career growth and above all, improve health!

This position reports to the Executive Director of Clinical Outcomes and is an hourly, full-time, (non-exempt) position.

QUALIFICATIONS:

Education and experience:

• Bachelor degree in nursing is desired
• One (1) year case management or utilization management experience preferred

Knowledge & Skills

• Knowledge in areas of Medicare and Medicaid UM regulations
• Milliman’s
• Medicare Inpatient Only List
• RAC, QIO, MAC and Denial Management
• URAC guidelines
  

Licensure, registration and certification:

• Must have proof of maintenance of current licensure in State of Kansas or 
• Multi-State License Specialty Certification preferred within two (2) years 

NMC Health offers competitive pay with rich differentials.

Join our Team! NMC Health offers a family friendly environment with the latest technology and a knowledgeable staff. Here you’ll find all departments work together as a team to live out our core values: respect, excellence, service, transparency, and trust.

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