RN Manager, Utilization Managment - Post Acute
Location: Akron
Posted on: June 23, 2025
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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
Keywords: , Cuyahoga Falls , RN Manager, Utilization Managment - Post Acute, Healthcare , Akron, Ohio
