Manager Utilization Management

SCL Health
Billings, MT
Post Date:
September 04, 2021
Job Status:



You bring your body, mind, heart and spirit to your work as a Manager Utilization Management.


You know when to move quickly. When to sit quietly. When to laugh loudly.


You understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations, working hard to provide the best coordination of care to our patients.


Youre great at what you do, but you want to be part of something even greater. Because you believe that while individuals can be strong, the right team is invincible.




St. Vincent Healthcare is part of SCL Health, a faith-based, nonprofit healthcare organization that focuses on person-centered care. Our 286-bed level II trauma center has provided care in Montana and the surrounding area since 1898, and our 30-clinic network ensures community needs are met. We offer comprehensive, specialty care, including a hospital within a hospital specifically for children, and are proud to extend SCL Healths missions by treating the poor, the vulnerable, our community and each other.


Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: it encompasses body, mind and social well-being. To that end, weve launched a Healthy Living program to address your holistic health. Healthy Living includes financial incentives, digital tools, tobacco cessation, classes, counseling and paid time off. We also offer financial wellness tools and retirement savings plan. To show our commitment to you and to assist with your transition into our organization, we may also offer a sign-on or retention bonus and relocation assistance when applicable.


With this position, you are eligible to participate in the At Risk Compensation (ARC) Plan. This plan enables SCL Health to provide leaders with an additional performance compensation opportunity. The ARC Award opportunities are calculated as a percentage of your base salary. Awards are paid out based on attainment of selected SCL Health Board-approved goals.




Together well align mission and careers, values and workplace. Well encourage joy and take pride in our integrity.


Well laugh at each others jokes (even the bad ones). Well hello and high five. Well celebrate milestones and acknowledge the value of spirituality in healing.


Were proud of what we know, which includes how much there is to learn.


Your day


As a Manager Utilization Management you need to know how to:

  • Consult with physicians, physician advisors, care managers, and other members of the interdisciplinary care team to develop improved utilization of effective and appropriate services.
  • Participate in and may facilitate Utilization Committee meetings and initiatives. Participate in and/or facilitate multi-disciplinary patient rounds.
  • Use nationally recognized review criteria to ensure that patient status is at the appropriate level of care. Collaborate with physicians and care managers to support an appropriate and timely patient discharge.
  • Perform initial review and authorizations for admission. Perform concurrent reviews to ensure that extended stays are medically necessary and justification is documented in the medical record. Perform ongoing review of precertification and retrospective review for medical necessity. Participate in continued stay reviews. Communicate with attending physician regarding questions about continued length of stay, plan of care/discharge, and physician orders.
  • Refer appropriate cases to the designated Physician Advisor in accordance with established guidelines for admission status or continued stay.
  • Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
  • Review medical records and prepares for appropriate clinical appeals.
  • Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
  • Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
  • Documents all UR interventions in appropriate electronic record.
  • Coordinate orientation and training of new associates. Ensure staff competency through proper training techniques and conducts quality audits.

Your experience


We hire people, not resumes. But we also expect excellence, which is why we require:

  • Current valid state RN Licensure is required.
  • Five (5) years utilization review experience required, including two (2) years hospital utilization review.
  • Supervisory or management level experience in hospital setting preferred.

Your next move


Now that you know more about being a Manager Utilization Management on our team we hope youll join us. At SCL Health youll reaffirm every day how much you love this work, and why you were called to it in the first place.


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