Manager Clinical Review - Hybrid

At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs.  Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.

Discover why Cooper University Health Care is the employer of choice in South Jersey.

Under the direction of the AVP of Care Management and Healthcare Access, the Manager of Clinical Review maintains daily operations of the hospital Clinical Review Department.  Excellent communication and interpersonal skills. Team building skills with the ability to function independently and interdependently as a member of the Care Management Leadership Team. Demonstrates the ability to be flexible in work schedules and coverage; this includes the ability to manage some staff remotely. Strong organizational, innovation, and problem-solving skills. Strong decision-making skills.  Ability to establish strong team building with the both internal and external customers.

Manages daily UM operations for the department including staffing, schedules, recruitment, onboarding, and performance management. Monitors departmental performance indicators, goals and objectives that are consistent with organizational strategic goals, mission, and vision. Monitors reports and workqueues and implements change accordingly.  Maintain the quality of the review process among all personnel including development and implementation of staff audits that give meaningful and measureable data and an understanding of strengths and areas for improvement. Responsible for the development and implementation of process improvements.  Reviews observation/SDS cases daily and initiates communication and referral activity to ensure correct status designation. Collaborates with Physician advisors and AVP to assure UM workflows are being addressed according to the UM plan, and active participant in the UM committee.

The above are guidelines for the position but are not necessarily a delineation of all the actions/duties necessary to the job.

Required: minimum of 5  years Nursing Experience, minimum of 2 years Clinical Review. Preferred 2 year direct management experience in clinical review.

Required: BSN

Preferred: Master's degree in nursing, Business, Health Care Management

Required: NJ Registered Nurse License. Preferred: Certification in Case Management

Interqual and MCG Guideline experience preferred.

Strong communication (written and verbal) and critical thinking skills required. 

Process redesign, project and change management experience preferred.

Knowledge and understanding of managed care contract language, Medicaid, CMS guidelines, and third party payor guidelines preferred.