RN Manager, Utilization Managment - Post Acute

Location: Akron
Posted on: June 23, 2025

Job Description:

SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Summary: Perform duties to conduct and manage the day-to-day operations of the utilization management function for post-acute utilization services. Communicate with staff to facilitate daily department functions including prior authorization for post-acute services related to Long Term Acute Care Hospital (LTACH), Acute Rehabilitation (AR), and Skilled Nursing Facilities (SNF), Discharge Planning and transitions of care. Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs. Meets organizational, operational and service goals related to quality outcomes, member experience, and cost-efficiency. Formal Education Required: a. Bachelor’s degree or equivalent combination of education and/or experience b. Licensed as a Registered Nurse in the state of Ohio c. Case Management Certification (CCM, ACM) preferred Experience and Training Required: a. Three (3) years performing post-acute utilization management/ discharge planning activities and minimum of four years relevant clinical experience. b. Experience including prior authorizations, post -acute clinical nursing, health plan management, working knowledge of Medicare and/or Commercial plan designs, and/or experience with clinical regulatory and accrediting guidelines preferred c. Prior management/leadership experience required, preferably in post-acute areas and/utilization management, or health plan management. d. Knowledge of clinical authorization criteria required. Knowledge of InterQual or MCG preferred. Must be knowledgeable of CMS post-acute admission requirement. e. Moderate computer skills and familiarity with Outlook, Word, Excel, PowerPoint required. Able to interpret data reports. f. Knowledge of Epic preferred Other Skills, Competencies and Qualifications: a. Flexible: Ability to adapt to meet business needs. b. Access to own vehicle for occasional travel to area post-acute facilities. c. Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity Level of Physical Demands: a. Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously. Equal Opportunity Employer/Veterans/Disabled $40.74/hr - $61.11/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. Basic Life and Accidental Death & Dismemberment (AD&D) Supplemental Life and AD&D Dependent Life Insurance Short-Term and Long-Term Disability Accident Insurance, Hospital Indemnity, and Critical Illness Retirement Savings Plan Flexible Spending Accounts – Healthcare and Dependent Care Employee Assistance Program (EAP) Identity Theft Protection Pet Insurance Education Assistance Daily Pay

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