Asante Health System

Supv Utilization Review (Case Management)

Posted on

March 16, 2025

Job Type

Full-Time

Role Type

Leadership / Management

License

RN

State License

Oregon

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Company Description

At Asante, we are guided by our values below. Explore Asante more by visiting www.asante.org/careers Excellence - Respect - Honesty - Service - Teamwork

Job Description

Supv Utilization Review (Case Management) Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM PLEASE NOTE: This position may be remote. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include working day-to-day operations during Pacific Standard business hours or online training.

Requirements

Experience: A minimum of 2 years of demonstrated leadership in utilization review/clinical documentation integrity within a health care environment, with emphasis on community health resources and program development is required An additional 2 years of nursing experience in clinical practice areas such as acute care hospital, physician clinics, quality, case management, performance improvement, informatics is required Education: Bachelor's degree in nursing, or equivalent education and experience is preferred Required Certification/Licensure RN: Registered Nurse (RN) by the Oregon State Board of Nursing or Allied Health Provider Preferred Certifications/Licensures CCM: Certified Case Manager (CCM) or ACM: Accredited Case Manager (ACM) CCS: Certified Coding Specialist (AHIMA) CPC: Certified Professional Coder (AAPC) CCS-P: Certified Coding Specialist - Physician Based (AHIMA) CRC: Certified Risk Adjustment Coder (AAPC)

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Responsibilities

The Supervisor of Utilization Review is responsible for overseeing the daily operations of the utilization review team, ensuring compliance with payer guidelines, optimizing resource utilization, and facilitating appropriate patient care decisions. This role provides leadership, training, and guidance to UR staff while collaborating with clinical teams, revenue cycle, and payer representatives to minimize denials and improve reimbursement outcomes.

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