Inpatient UM Manager

2 weeks ago


Canton, Massachusetts, United States Point32Health Full time
Job Summary

The Inpatient UM Manager is responsible for overseeing the day-to-day operations of the Utilization Management (UM) Process and managing Utilization Management Clinicians. This role involves medical management activities related to utilization and discharge planning for acute inpatient, LTAC, rehabilitation, and skilled nursing facilities, as well as Out of Network Management. The Inpatient UM Manager is accountable for implementing, monitoring, and overseeing department functions and programs, ensuring the delivery of defined metrics to validate business unit/program effectiveness.

Key Responsibilities
  • Business Process Implementation and Oversight
    • Develop, implement, and evaluate new and existing Commercial and Public Plan medical management programs for inpatient utilization and discharge planning, including telephonic and onsite utilization management across the inpatient level of care.
    • 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, documentation standards, and activities.
    • Ensure compliance with applicable state, federal, and regulatory and accrediting agencies, including maintaining timely audit/reporting cycles.
  • Staff Development
    • Provide direct oversight of Team Managers within jurisdiction.
    • Guide and enhance the professional development of the team manager and staff, providing coaching, feedback, and direction through a development plan to ensure successful achievement of business and professional goals.
  • Resource Management
    • Support budget process and oversee the management of department resources.
    • Accountable for realization of department administrative budget targets.
Qualifications
  • BS degree in nursing required.
  • Master's degree preferred (nursing, business, healthcare administration), or equivalent experience.
  • Registered Nurse with current Massachusetts license preferred.
  • 7 years' Registered Nurse, Leadership experience in managed care systems and required.
  • Demonstrate sound knowledge of utilization management and case management principles.
Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams, and provide parameters on how to recruit and retain talented and dynamic talent.



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