Pediatric Utilization Management Jobs in Arizona

This position is responsible for the overall leadership, strategic direction and operations oversight of Phoenix Children`s Care Coordination Departments across the enterprise, including Inpatient Care Management, Utilization Management and Social Work. This position is accountable for ensuring coordination of patient information with nursing floor management and ensuring close daily communication, as well as, being responsible for the development and implementation of a comprehensive Care Coordination, specific to Care Management, Utilization Management, and Social Work, designed to ensure the patient/family experience from end-to-end is positive, family-centered, accessible and accurate. This position manages existing Care Coordination vendor relationships, implements and manages a population health program, and collaborates with other key stakeholders to ensure patients are successfully transitioned to Phoenix Children’s Care Navigation programs with the goal of improving clinical outcomes through advocacy, partnership and innovation, while lowering the cost of healthcare.

• Provides leadership to assigned departments, partners with the VP of Revenue Cycle to develop strategies, implement policies and procedures, and develop KPIs to meet financial and non-financial goals.
• Directs, manages and evaluates the effectiveness and efficiency of Social Work, Case Management and Utilization Management by establishing controls and reviewing associated procedures.
• Manages day‑to‑day operations ensuring compliance with regulatory and legal requirements and quality standards that meet or exceed community standards of care.
• Identifies and manages improvement initiatives, develops clear business and project plans, and implements corrective measures to enhance performance.
• Performs organizational and administrative duties, manages the department budget, prepares financial reports, evaluates systems, and oversees vendor relationships.
• Demonstrates exceptional customer service, builds teamwork, maintains relationships with patients and care providers, and collaborates with other departments to solve complex interdepartmental issues.
• Develops team members through timely feedback, HR policies, and training opportunities to achieve professional growth.
• Performs miscellaneous job‑related duties as requested.

Mission: To advance hope, healing and the best healthcare for children and their families.

Vision: Phoenix Children`s will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

Values:

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable

• Bachelor's degree in Nursing. Required
• Current credentials in Case Management or Social Work or equivalent experience. Required
• Master's degree in Nursing, Management, Organizational Development, or related field. Preferred

• Ten (10) or more years of experience in case management or social work. Required
• Five (5) or more years of managerial experience in an acute care hospital. Required
• Five (5) or more years leading functions/departments supporting families with hospital resources, community resources, and/or resource/utilization management such as Social Work, Financial Counseling/Eligibility, and/or Case Management. Required
• Pediatric experience. Preferred

• Working knowledge of ICD-9 and ICD-10 coding, MCG, Interqual, financial clearance, revenue cycles, and reimbursement, decision‑making, leadership, computer skills, and communication. Required
• Extensive knowledge of Milliman guidelines and Allscripts Care Management. Preferred

• Current State of Arizona RN License or an RN License from a compact state with multistate privileges. Required
• Valid Arizona Department of Public Safety Fingerprint Clearance Card. Required
• Certified Care Manager or Certified Case Manager Certification (CCM). Preferred

• Climbing - Frequently
• Sensing textures and temperatures - Frequently
• Fine Motor Skills - Frequently
• Hearing - Frequently
• Pushing/pulling - Frequently
• Reaching - Frequently
• Sitting - Frequently
• Standing - Frequently
• Stooping/crouching/kneeling/crawling - Frequently
• Talking - Frequently
• Tasting/smelling - Frequently
• Walking - Frequently
• Near Vision - Frequently
• Far Vision - Frequently
• Color Discrimination - Frequently
• Use of keyboard, mouse and/or computer equipment - Frequently
• Lift up to 35 pounds without assistance - Occasionally
• Lift more than 35 pounds without assistance - Occasionally
• Airborne communicable diseases - Applicable
• Bloodborne pathogens or bodily fluid - Applicable
• Fumes or airborne particles - Applicable