Inpatient Utilization Management Team Lead
2 weeks ago
We are seeking an experienced Inpatient Utilization Management Team Lead to join our team at Point32Health. As a key member of our Clinical Services department, you will be responsible for leading the Inpatient Utilization Management team in the development, implementation, and oversight of medical management programs for inpatient utilization and discharge planning.
Key Responsibilities- Business Process Implementation and Oversight
- Develop, implement, and maintain new and existing commercial and public plan medical management programs for inpatient utilization and discharge planning.
- Collaborate with case management program leaders to support transition of care needs, complex discharge planning, and high-risk members.
- Establish written policies and procedures pertaining to commercial or public plan utilization management and transition of care/discharge planning program processes.
- Staff Development
- Provide direct oversight of team managers within jurisdiction.
- Guide and enhance the professional development of team managers and staff.
- Collaborate on development and ensure maintenance of an evidence-based training program.
- Resource Management
- Support budget process and oversee the management of department resources.
- Accountable for realization of department administrative budget targets.
- Corporate Participation
- Represent Clinical Services/Inpatient Management in relevant corporate teams as required.
- Implement and support fulfillment of corporate goals through defined, measurable department goals.
- Education, Certification, and Licensure
- BS degree in nursing required.
- Master's degree preferred (nursing, business, healthcare administration), or equivalent experience.
- Registered Nurse with current Massachusetts license preferred.
- Experience
- 7 years' Registered Nurse, leadership experience in managed care systems required.
- Demonstrate sound knowledge of utilization management and case management principles.
- Experience will demonstrate a functional knowledge of utilization management within a variety of payment models.
- Skill Requirements
- Ability to work cooperatively as a team member across multiple levels within the organization.
- Results orientation to meet business goals.
- Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and Point32Health information systems.
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Canton, Massachusetts, United States Point32Health Full timeJob SummaryThe Inpatient Utilization Management Team Manager is responsible for overseeing the day-to-day operations of the Inpatient Utilization Management (UM) process. This includes managing Utilization Management Clinicians, implementing and monitoring department functions and programs, and delivering defined metrics to validate business unit/program...
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