OverviewThe UM Manager & Admissions Analysis is responsible for leading the operational and analytical functions that support admission status accuracy, medical necessity compliance, regulatory adherence, and reimbursement optimization across the UF Health enterprise. This position oversees admission review workflows, admission status analytics, denial prevention strategies, and performance monitoring related to inpatient, observation, and outpatient bedded patient populations. Working collaboratively with Utilization Management, Physician Advisors, Case Management, Clinical Documentation Integrity (CDI), Revenue Cycle, Patient Financial Services, Managed Care, and physician leadership, the manager will leverage data analytics to identify trends, ensure compliance with CMS and payer requirements, reduce denials, and improve patient status accuracy and financial performance. The role aligns with enterprise goals of standardization, operational excellence, regulatory compliance, and revenue integrity. The scope aligns with enterprise manager-level operational leadership expectations focused on daily operations, quality, compliance, staff development, and process improvement.
QualificationsEducation- Bachelor's degree in nursing.
- Master's degree in nursing, Healthcare Administration, Public Health, Business Administration, or related field preferred.
Experience- Minimum five (5) years of utilization management, case management, revenue cycle, or payer relations, denial management or healthcare operations experience.
- Minimum three (3) years of leadership experience.
- Experience with admission status reviews, medical necessity determination, and payer regulations.
- Experience working with Medicare, Medicaid, and commercial payers.
- Experience with complex health system or academic medical centers is strongly preferred.
- Experience with physician advisor programs.
- Epic experience a must.
- Ability to interpret regulatory requirements and translate them into operational processes.
- Ability to manage multiple priorities and lead through organizational change.
License/Certification/Registration- Registered Nurse (RN) required.
- Accredited Case Manager (ACM) preferred.
- Certified Case Manager (CCM) preferred.
- Certified Professional in Healthcare Quality (CPHQ) preferred.
- Certification in Healthcare Quality and Management (HCQM) preferred.
- Certified Professional in Utilization Review (CPUR) preferred.
- Lean/Six Sigma preferred.
- Certified Revenue Cycle Representative (CRCR) preferred.
