Nurse Manager - Utilization Management — Phoenix, AZ at

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans to take care of you and your family, now and in the future. With continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.

Our reputation has spread beyond our Minnesota roots. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota, as well as at Mayo Clinic Health System campuses throughout Midwestern communities and our international locations. Each Mayo Clinic location is a special place where employees thrive in both their work and personal lives.

About the Role

The RN Manager, Care Management provides leadership, direction, and resource management for case managers and social workers across inpatient and ambulatory settings. This role exists to effectively resolve utilization review and denial management issues while removing barriers and complexities for staff to facilitate safe discharge planning.

You will collaborate internally with pre-certification staff, admitting and billing personnel, house supervisors, risk management, and physicians to maximize patient flow. Externally, you will partner with health plans, providers, and vendors to ensure needs are met from the patient's point of entry through discharge. This position requires a strong working knowledge of Medicare/Medicaid, regulatory compliance mandates, and national and local coverage determinations.

Beyond operational oversight, you will assist in developing the department's vision, fostering a teamwork-oriented and creative environment. You will coordinate staff development, manage performance proactively, and support leadership activities including community involvement and research participation. This role provides direct supervision of utilization management and denials as part of a leadership team covering post-acute programs and ambulatory case management.

Hiring Process

This role is eligible for TN sponsorship. Successful sponsorship will require state licensure and completion of the VisaScreen or equivalent certification.

Equal Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status, or disability status. Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

Work location

Work model: On-site

Phoenix City Hall, 200, West Washington Street, Central City, Phoenix, Maricopa County, Arizona, 85003, United States

Phoenix, Arizona

Key Responsibilities

check_circleProvide leadership and resource management for case managers and social workers
check_circleResolve utilization review and denial management issues
check_circleCoordinate staff development and proactively manage staff performance
check_circleSupport staff leadership through committee participation and community involvement
check_circleCoordinate external partnerships with health plans and vendors to maximize patient flow
check_circleCollaborate internally with physicians, billing, and risk management to facilitate safe discharges
check_circleDevelop department vision and foster a creative, team-oriented work environment
check_circleDirectly supervise utilization management and denial processes

Requirements

verifiedBachelor's degree in nursing required
verifiedMaster's degree in nursing preferred
verifiedMinimum 3 years nursing practice or progressive leadership experience
verified5 years hospital-based case management preferred
verifiedState licensure required
verifiedVisaScreen or equivalent certification required for TN sponsorship
verifiedKnowledge of Medicare/Medicaid and payer sources
verifiedStrong inpatient utilization review knowledge
verifiedProficiency with computers

Nice to Have

Master's degree in nursing. Five years of hospital-based case management, including discharge planning and utilization review experience.

Benefits & Perks

check_circleMultiple medical plan optionscheck_circleDental coverage via Delta Dental or reimbursement accountcheck_circleVision plan with national networkcheck_circlePre-tax savings through HSA and FSACompetitive retirement package

Skills, education and keywords

Skills: Case Management, Discharge Planning, Utilization Review, Denial Management, Medicare, Medicaid, Regulatory Compliance, Auditing, National Coverage Determinations, Local Coverage Determinations.

Education: Bachelor's degree in nursing required; Master's degree in nursing preferred.

Frequently asked questions about Nurse Manager - Utilization Management at Mayo Clinic

What does a Nurse Manager - Utilization Management at Mayo Clinic do?expand_more

A Nurse Manager - Utilization Management at Mayo Clinic is responsible for the following: Provide leadership and resource management for case managers and social workers; Resolve utilization review and denial management issues; Coordinate staff development and proactively manage staff performance; and Support staff leadership through committee participation and community involvement.

What are the requirements for this Nurse Manager - Utilization Management role?expand_more

To qualify for the Nurse Manager - Utilization Management at Mayo Clinic position, applicants should have: Bachelor's degree in nursing required; Master's degree in nursing preferred; Minimum 3 years nursing practice or progressive leadership experience; 5 years hospital-based case management preferred; State licensure required; and VisaScreen or equivalent certification required for TN sponsorship.

Where is the Nurse Manager - Utilization Management role at Mayo Clinic located?expand_more

Nurse Manager - Utilization Management at Mayo Clinic is based in Phoenix City Hall, 200, West Washington Street, Central City, Phoenix, Maricopa County, Arizona, 85003, United States. This is a on-site role.

Is this Nurse Manager - Utilization Management job remote, hybrid, or on-site?expand_more

Mayo Clinic has listed this Nurse Manager - Utilization Management role as on-site.

How much experience is required for this Nurse Manager - Utilization Management role?expand_more

Candidates for Nurse Manager - Utilization Management at Mayo Clinic should have mid level.

What skills do you need for the Nurse Manager - Utilization Management role at Mayo Clinic?expand_more

Key skills for Nurse Manager - Utilization Management at Mayo Clinic include Case Management; Discharge Planning; Utilization Review; Denial Management; Medicare; Medicaid; Regulatory Compliance; and Auditing.

What education is required for Nurse Manager - Utilization Management at Mayo Clinic?expand_more

Educational requirements for this role: Bachelor's degree in nursing required; and Master's degree in nursing preferred.

What category does the Nurse Manager - Utilization Management role belong to?expand_more

Nurse Manager - Utilization Management at Mayo Clinic is part of the healthcare & nursing job category on Recrutus.

Nurse Manager - Utilization Management