How much does a Quality Assurance (QA) Utilization Review Manager make in the United States?

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The Care and Utilization Review Nurse Manager oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Being a Care and Utilization Review Nurse Manager requires a bachelor's degree. Experienced in utilization review techniques and protocols. In addition, Care and Utilization Review Nurse Manager typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Care and Utilization Review Nurse Manager supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Working as a Care and Utilization Review Nurse Manager typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. View Care and Utilization Review Nurse Manager Salary

The Care and Utilization Review Nurse Coordinator ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Coordinates utilization reviews of managed care contracts using established guidelines and processes. Being a Care and Utilization Review Nurse Coordinator maintains managed care contracts and information databases and prepares reports. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. In addition, Care and Utilization Review Nurse Coordinator typically requires an associate's degree of Nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). Being a Care and Utilization Review Nurse Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. Working as a Care and Utilization Review Nurse Coordinator typically requires 5-7 years of related experience. View Care and Utilization Review Nurse Coordinator Salary

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. View Utilization Review Coordinator Salary

Quality Assurance Manager is responsible for the implementation of policies and procedures to ensure adherence to production quality standards. Monitors and audits process, material, and product testing against established standards and conducts a continuous analysis of quality defects and deviations. Being a Quality Assurance Manager identifies deficiencies or gaps in testing activities and develops solutions to ensure adequate and robust quality processes. Optimizes processes to comply with existing and new regulatory requirements. Additionally, Quality Assurance Manager typically requires a bachelor's degree. Typically reports to a director. The Quality Assurance Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Quality Assurance Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. View Quality Assurance Manager Salary