Nurse Manager - Utilization Management (Full Time)

Essential Duties & Responsibilities including but not limited to:

• Ensures that Utilization Review nurses are consistently recommending the appropriate admission status and provides education as needed.
• Interacts with physicians to manage high risk patients most likely to benefit from Utilization Review intervention.
• Serves as a resource person for the Utilization Review staff and others to ensure consistent and accurate patient status determinations for appropriate claim submission.
• Collaborates with all member of the multidisciplinary team to ensure that all patients are reviewed appropriately and the correct admission status is applied.
• Manages the performance of all Utilization Review staff, coaching as needed and administering corrective action when appropriate.
• Manages the performance of all UM staff, completes and monitors audits, facilitates corrective action as needed.
• Completes annual colleague performance evaluations for all Utilization Review staff.
• Conducts new employee interviews and selects new employees.
• Identifies, develops and provides orientation, training, and competency development for appropriate staff on an ongoing basis.
• Assigns and reviews staff schedules and workflows and works closely with other administrative and clinical areas under the direction of the Executive Director and the VP of Revenue Cycle/Chief Revenue Officer as part of an integrated Revenue Cycle model.
• Ensures the Utilization Review department maintains documented, up-to-date policies and procedures and that key processes have valid outcome measures that are monitored for compliance and reported to a variety of audiences.
• Performs a variety of concurrent and retrospective Utilization Review-related activities, ensuring that appropriate data is tracked, evaluated, and reported.
• Monitors the effectiveness/outcomes of the Utilization Review program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed.
• Leads and/or actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff.
• Assists the Executive Director in evaluating systems and processes in close collaboration with other revenue cycle and clinical areas.
• Assists leadership in managing vendor relationships, IT setup and reports, data analysis, compliance reviews as needed.
• Continuously monitors regulatory requirements for Utilization Management.
• Attends Mandatory Education programs required by the organization.
• Keeps current on both department and organizational activities by reviewing various communications and literature that include staff meeting minutes, newsletters, staff assemblies, etc.
• Attends work related educational programs as required. 
• Maintains necessary continuing education requirements for licensing, certification and enhancements.
• Maintains own education records.
• Organizational Requirements:
• Maintains strict adherence to the LHMC and BILH Confidentiality Policy.
• Incorporates LHMC Guiding Principles, Mission Statement and Goals into daily activities. 
• Complies with all LHMC Policies. Complies with behavioral expectations of the department and LHMC Clinic.
• Maintains courteous and effective interactions with colleagues and patients.
• Demonstrates an understanding of the job description, performance expectations, and competency assessment.
• Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
• Participates in departmental and/or interdepartmental quality improvement activities.
• Participates in and successfully completes Mandatory Education.
• Performs all other duties as needed or directed to meet the needs of the department.