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Utilization Management Nurse Supervisor
2 months ago
Nurse Manager - Utilization Management
Position Overview:
This role involves overseeing the daily functions of the Utilization Management Program within a designated Service Area or Medical Center. The Nurse Manager is responsible for ensuring efficient and high-quality patient care through the effective use of resources. This position provides leadership to various staff members, including those involved in Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and other related functions.
Key Responsibilities:
- Contributes to the development and maintenance of policies and procedures pertinent to Utilization Management within the Service Area or Medical Center.
- Works collaboratively with interdisciplinary teams to plan and coordinate patient care throughout the healthcare continuum.
- Oversees and manages patient care in collaboration with hospital facilities and healthcare providers, identifying risk management and quality care issues.
- Brings forth issues and recommendations to the relevant interdisciplinary team members.
- Manages the transportation program to ensure the optimal use of resources that align with Health Plan guidelines and patient requirements.
- Ensures adherence to Federal, State, TJC, NCQA, and other regulatory standards and internal policies.
- Guides staff in utilization review, care coordination, discharge planning, and additional services across the care continuum.
- Assists in performing statistical analyses on utilization trends, patterns, and outcomes.
- Responsible for hiring, training, coaching, and managing professional and clerical support personnel.
Qualifications:
- A minimum of three (3) years of experience in utilization management and discharge planning within an acute care environment, including supervisory or management experience.
- Bachelor's degree in Nursing (BSN) or a related healthcare field such as management or health services administration.
- Possession of a Registered Nurse License (California).
- Certification as a Case Manager is advantageous.
Additional Requirements:
- Proven knowledge of healthcare operations and management, including TJC, Title XXII, Medicare, MediCal, and other relevant regulations.
- Understanding of managed care operations.
- Strong interpersonal, negotiation, and management capabilities.
- Excellent verbal and written communication skills.
- Ability to function effectively in a Labor/Management Partnership environment.
Compensation:
- Competitive salary range of $165,000 - $175,000.
- Comprehensive benefits package available.
