Swedish Health Services Supervisor, Utilization Management - Case Management Team in Seattle, Washington
Swedish Medical Center is hiring for a Supervisor to support our Utilization Management Department (1.0 FTE, Days) in Seattle, WA
The Supervisor, Utilization Management will provide a key system role in facilitating and managing the utilization management program for Swedish Health System. The Supervisor has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. Demonstrated clinical expertise related to a wide variety of patient populations and care delivery models.
This individual supports the program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to utilization management to effectively lead the team.
The Supervisor partners with the Manager of Utilization Management to identify opportunities for the development, implementation, evaluation, and ongoing revision of initiatives to improve quality, continuity, and cost-effectiveness. Develops and monitors a quality improvement plan for utilization management functions/processes. Provides routine reports to the department Manager. Proactively communicates with the Manager of variances and recommended action plans.
In this position you will:
Be responsible for ongoing success of Utilization Management Program across Swedish system
Demonstrated understanding of compliance and regulatory requirements from Center for Medicare and Medicaid. Services, payor contractual requirement and other regulatory agencies
Develop and supervises the implementation of department policies and procedures to assure compliance with statutory, regulatory, accreditation, and contractual requirements
Extensive knowledge of all aspects of utilization management: prior-authorization, status determination, continued stay review and denial management (concurrently and retrospectively)
Demonstrated ability to evaluate patient status, continued stay and other utilization management activities utilizing criteria platforms
Required qualifications for this position includes:
Bachelor's Degree in Nursing
Current RN license in the State of Washington
Five (5) years of recent acute care experience
Two (2) years of recent Case Management/Utilization Management experience
Preferred qualifications for this position includes:
Master's Degree in Nursing, Business, Healthcare Administration, or other related field
Coursework/Training: ACM or CCM Certification
Progressive leadership experience in Case Management/Utilization Management
About Swedish Shared Services.
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, , a network of more than 128 primary care and specialty care locations throughout the Puget Sound area.
Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
Our Mission is to improve the health and well-being of each person we serve.
Our Vision is Health for a Better World.
Swedish is the largest not-for-profit health care system in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty center in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, a network of more than 128 primary care and specialty care locations throughout the greater Puget Sound area. Swedish employs nearly 13,000 caregivers (all employees), including nearly 1,400 providers. Whether through physician clinics, education, research and innovation or other outreach, we're committed to caring for the people in our region and beyond. Swedish is proud to be an Equal Opportunity Employer Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Clinical Lead Supervisor/Manager
Work Locations: Metropolitan Park East (WA152) 1730 Minor Avenue Metropolitan East Tower Seattle, 98101
Req ID: 295417