Utilization Review and Clinical Program Manager
Description
About Lakewood
Lakewood Health System is a comprehensive rural healthcare system in central Minnesota. Leading the way in providing quality, personalized healthcare for a lifetime, Lakewood prides itself on remaining fiercely independent to prioritize its patients, staff, and communities in all decisions. Voted as one of Star Tribune’s Top Workplaces for the sixth year in a row, we do rural healthcare differently at LHS by providing a solid foundation of family practice providers with access to best-in-class specialty services, all right here at Lakewood. Across the spectrum of life, Lakewood Health System provides compassionate, quality care for the Brainerd Lakes region and beyond.
About the Department
The Nursing Administration department provides leadership and support for clinical operations, patient care quality, and regulatory compliance throughout Lakewood Health System. The department works collaboratively with providers, nursing teams, and interdisciplinary departments to promote safe, effective, and efficient patient care.
Mission for Position
The Utilization Review and Clinical Programs Manager is responsible for overseeing utilization review activities to support medical necessity, appropriate patient status, denial prevention, and effective utilization of healthcare resources. This position also provides leadership and coordination for Lakewood Health System's trauma and stroke programs, ensuring compliance with regulatory requirements and maintaining program designation readiness. The manager collaborates with Nursing Administration, medical directors, and interdisciplinary teams to strengthen clinical processes, improve quality outcomes, and support patient-centered care.
Duties & Responsibilities
The Utilization Review and Clinical Programs Manager conducts medical necessity reviews using MCG criteria, monitors patient status and length of stay, identifies documentation opportunities, and supports payer reviews, denial prevention, and appeals. This role also serves as the designated Trauma Program Manager and Stroke Coordinator, overseeing program compliance, performance improvement initiatives, required reporting, education, and designation readiness. Additional responsibilities include collaborating with medical directors, providers, nursing, care management, and other departments to improve clinical processes, support regulatory compliance, and promote effective resource utilization.
Position Type
This is a full-time, (1.0 FTE) position.