Nurse Director, Hospital Utilization Management

Job Summary :

In addition to the responsibilities below, this position is also responsible for establishing best practice models; performing strategic planning and designing patient care delivery systems and practice standards in several locations; leading the investigation of patient / family / member concerns regarding patient care and services; partnering with physicians, outside healthcare providers, and other health care team members to achieve optimal and safe patient care across the continuum; managing resource needs in clinical areas to ensure appropriate assignment and utilization; evaluating the use and maintenance of equipment, supplies and medications; assuming accountability for patient and employee safety; maintaining clinical expertise, providing clinical supervision, competency and licensing necessary to fulfill job responsibilities and to direct the provision of care in the unit; delegating tasks and duties that are aligned to scope of practice; and performing clinical duties as required.

Essential Responsibilities :

Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.

Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and / or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.

Directs hospital administrative functions to support patient care by : approving timelines, considering the development of strategies with stakeholders to identify factors contributing to business value; developing and reviewing ad hoc reports and workflows, directing department response and assuming accountability for department performance targets; championing short- and long-term operational initiatives and directing program, services, and / or systems development; aligning cross-functional programs including workplace and patient safety, human resources (e.g., recruitment, selection, promoting active recruitment, performance evaluation and management), labor relations, training and development, and quality / risk management issues with KPs mission and values; directing continuous survey readiness activities including mock rounds and mitigating issues to maintain compliance and regulatory standards, and reviewing prepared audit documentation, information, and reports; and overseeing the development of budgets for assigned areas (e.g., branch office, staffing, business services departments) and ensuring overall financial performance meets expectations.

Manages care delivery operations and programs within a twenty-four-hours-a-day, seven-days-a-week operational environment by : partnering with physicians and other clinical leaders to align key care delivery initiatives across KP, providing oversight over all workstreams; overseeing the development and implementation of long-term plans, policies, and processes for data-gathering and analysis while ensuring guideline and regulation alignment; driving cross-functional patient management solutions with internal and external leaders; aligning resources in hospital areas to ensure appropriate assignment and utilization; directing multidisciplinary hospital team(s) and holding team(s) accountable for performance; collaborating on and overseeing the design of emergency preparedness programs; adjusting departments emergency preparedness and recovery plans as needed, ensuring managers and staff are trained and understand expectations for during and after an emergency; providing strategic direction to project teams leading initiatives and ensuring implementation, equitable distribution of resources, and delivery on objectives; and overseeing teams responsible for the delivery of nursing services and patient care within a twenty-four-hours-a-day, seven-days-a-week operational environment in alignment with cost, quality, and clinical and utilization standards.

Directs improvements to operations and technology processes by : driving internal and external strategic projects designed to achieve goals related to issue remediation and improved quality, service, affordability, and / or operating efficiency; defining standards for clinical teams to identify root causes of escalations, make recommendations, and implement solutions to improve the performance of operations system processes and address quality and safety issues; driving the development of strategic plans with the goal of achieving integrated services across the continuum of care in alignment with enterprise-wide goals; and consulting with senior and executive management to identify and implement relevant performance metrics to monitor the success of strategic improvement projects.

Ensures safe, quality, and standardized care delivery within a twenty-four-hours-a-day, seven-days-a-week operational environment by : developing and implementing strategies to support the continuous improvement of the quality and safety of clinical practices, services, and operations for patients and staff; holding managers accountable for maintaining compliance with legal and regulatory requirements (e.g., Nursing Practice Act, The Joint Commission [TJC], federal, state, and local requirements) updated by governmental and regulatory agencies; and establishing and monitoring outcome objectives including overseeing design and implementation for systems, processes, and methods to evaluate and improve patient care within assigned department and