Nurse Manager - Utilization Management

• Maintains current knowledge of all compliance and regulatory guidelines, UM best practices, emerging trends or legislation.
• Manages UM program within approved budget and reviews activities, costs operations, and forecasts data to determine progress toward stated goals and objectives.
• Oversees staff hiring and assist other UM leaders in training and orientation development.
• Develops talent, coaches staff, holds staff accountable for meeting external and/or internal customer needs.
• Interviews, trains, evaluates staff performance and yearly evaluations, and completes performance management of UM staff.
• Investigates and follows up on complaints grievances and quality issues related to patient acute stays or intradepartmental concerns.
• Ensures patient admission concurrent and retrospective review requests are performed using nationally recognized or governmental guidelines and criteria.
• Manages UM dept work queues and their day-to-day.
• Collaborates with other RCM or organizational partners to achieve dept and organization goals.
• Facilitates ongoing communication between UM staff and contracted providers to ensure authorizations are secured in a timely and efficient manner.
• Works collaboratively with other inter-dependent departments to achieve overall corporate objectives.
• Assist with project management and has ability to coordinate efforts to meet dept or organizational goals.
• Develops strong working relationship with physicians and other UM customers.
• Assist with education with UM customers or stakeholders.
• Promotes compliance with federal and state regulations and contractual agreements.
• Ability to compile and review multiple reports, perform data analysis, root cause analysis, monitor KPI's and performance opportunities on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management and suggest improvement plans.
• Offers creative suggestions and recommendations to resolve program challenges and obstacles, identifies opportunities for continuous improvement, increased efficiencies.
• Works with the Case Management Manager to develop education and training updates regarding best practices processes and standards related to regulatory compliance issues. Fosters positive relationships with CM and other organizational depts.
• Performs staff and chart audits to ensure adherence to dept policies, identify performance improvement opportunities, adherence to payor and governmental regulations and compliance.
• Assist in development and implementation of policies and procedures to reinforce high quality efficient workflows, can coordinate training, and educate staff on new changes.
• Ensures that staff maintains current knowledge of the InterQual criteria or other criteria adopted by the organization including governmental guidelines and criteria
• Ability to cover UM day-to-day operations in absence of Director.
• In addition to the above job responsibilities, other duties may be assigned.

MINIMUM REQUIREMENTS

Education: Bachelor's degree in nursing required; master's degree preferred.

Experience: Strong clinical background with 5 years acute care nursing experience required

Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia or compact licensure required. Utilization or Case Management Certification preferred.

PHYSICAL DEMANDS

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to

attend meetings, and programs.

The University of Virginia, including the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician's Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex, pregnancy, sexual orientation, veteran or military status, and family medical or genetic information.