Manager, Utilization Management (RN required) - REMOTE

Vanderbilt Health Utilization Management

Located in Nashville, Tennessee, Vanderbilt University Medical Center (VUMC) operates at a global crossroads of teaching, discovery, and patient care. It is a community of individuals who come to work each day with the simple aim of changing the world. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Job Summary

Coordinate, monitor, and evaluate the operation of Utilization Management Section of the Utilization Management Department of the Medical Center. Develop work goals for the section consistent with institutional and departmental goals and policy. Plan and align section performance with department scope of service parameters. Annually review current policies. Create, update and / or maintain section, department and applicable institution policies. Help unit to understand, share, and support the vision. Communicate operational changes real-time. Ensure the most effective operation of the section through program development, process improvement, and coordination of processes across functions. Monitor and coordinate programs and actions for : certification of urgent and emergently admitted cases and continued stay, for inpatients and outpatients in house beds; denial management; DRG / Clinical documentation program; tracking of avoidable day data; support of JCAHO initiatives; telemetry charging; and Kentucky Medicaid retrospective certifications; correct registration status to order. Supervise the section with responsibility for planning, coordinating and controlling the work and procedures of direct reports. Collaborate effectively with other VUMC departments including but not limited to Managed Care Services; Health Information Services; Pt. Accounting; VMG; Offices of Case Management and Social Work; Admitting; ED Registration; Physicians; Clinics; Patient Care Center administrators; Informatics Technology. Collaborate with UM Physician Advisor. Adjust work schedules or project priorities to meet emergencies or changing conditions through daily assessment of staffing needs and reprioritizing work accordingly. Provide information to others (oral or written) to explain / clarify problems or issues or requests; meet with other professional / technical personnel to determine causes of a specific problem. Elevate problem cases / trends to appropriate levels for decisions. Provide education, training to staff, physicians and others as needed to facilitate the success of section initiatives. Participate in periodic management meetings to keep top management informed of successes, problems and concerns; attend monthly department head meetings. Meet regularly with team leaders / supervisors to remain informed of successes, problems and concerns. Define and achieve financial targets for the section, consistent with the departmental financial plan. Provide oversight of the section budget expenditures to prevent any budgetary overages. Sign-off on purchase requisitions, work orders, 1180s and procurement card within approved parameters. Aid in the implementation, interpretation and presentation of annual wage and salary plan to staff Project section needs, long-term and short-term, forecasting and proactively addressing needs regarding equipment and staffing. Evaluate performance data for direct reports including UM / DRG specialists, data coordinator and clerical staff including volume of cases, errors and related write-offs. Address trends for performance improvement or recognize success. Closely monitor revenues impacted by the section (e.g. cases certified, denied, appealed, written off) and expenditures for all salary and non-salary expenditures in all centers for the entire section. Report findings that occur as part of the analysis process and incidental discoveries to the director / administrator Collect and analyze data for financial analysis and budgeting use. Exceed defined service standards for the section. Ensure that the service standards established for the section are met or exceeded. Ensure weekly Trac report and High Risk lists are completed timely. Monitor performance against service standards. Collect and analyze data for staff productivity measures and staffing needs. Meet regularly with team leaders / supervisors to review and address issues. Use patient / customer satisfaction data to improve systems, processes, and outcomes. Collaborate with consulting groups and internal auditors. Recognize and Reward staff accomplishments. Ensure a safe, satisfying and enriching environment for employees and provides a qualified, competent staff. Provide qualified competent staff, track projected staffing needs, and identify any deficiencies to improve staffing levels. Define the qualifications and performance expectations for all staff positions through the Performance Development system, including department specific job descriptions, measurable performance standards. Complete all performance reviews (3 mos., 6 mos. and annually) for staff timely. Enforce VUMC, Department and section policies consistently. Ensure that staff qualifications are consistent with job responsibilities. Verify for each employee or contracted personnel that, where relevant, education and training are consistent with applicable legal and regulatory requirements and hospital policy, that the individual is licensed, certified or registered, and that the individual's knowledge and experience are appropriate for the job assignment. Ensure staff is current with disaster plans; safety policies and procedures. Ensure the re-call (emergency notification) list is up-to-date; reference guides are up-to-date and distributed to other departments as needed. Create an environment that encourages and supports self-development and learning for all staff through regular feedback, by assuring the development of staff through orientation, training programs, work experiences and assessing competencies by meeting the performance expectations stated in his or her job description in a timely manner (normally annually). Conduct monthly section meetings with staff; hold called meetings as needed. Participate in Human Resources management / professional development workshops. Serve as a resource to other departments for questions, training and problem-solving. Monitor quality assurance standards, programs and procedures within the section. Ensure that defined quality standards are met within area of responsibility.

Technical Capabilities

Our Nursing Philosophy : We believe highly skilled and specialized nursing care is essential to Vanderbilt University Medical Center's mission of quality in patient care, education and research. We believe nursing is an applied art and science focused on helping people, families and communities reach excellent health and well-being. As a Vanderbilt University Medical Center employee, you make a difference to our patients and their families by bringing compassion and care to those in need of hope and healing. Please see our current employee benefits offered :

Affordable High Quality Health Plan Options

Dental and / or vision plan

403 (b) retirement plan

Paid Time off (flex PTO)

Tuition Reimbursement and adoption assistance (maximums applied)

Short-Long term disability

Subsidized backup childcare

And many more...

Ask us about our current inpatient nursing supplemental Pay Program!

Achieve the Remarkable : Learn more about VUMC Nursing here.

Core Accountabilities

Organizational Impact : Directs activities to achieve operational plans with some near term effect on results of the department / area.

Problem Solving / Complexity of work : Identifies issues, gathers facts to resolve technical and operational problems.

Breadth of Knowledge : Applies in-depth knowledge and skills of a professional / technical area and basic management knowledge to manage the work of the team.

Team Interaction : Leads a complex department with a focus on implementation. Typically executes on a short to medium term strategies.

Core Capabilities

Supporting Colleagues : Develops Self and Others : Invests time, energy, and enthusiasm in developing self / others to help improve performance e and gain knowledge in new areas.

Builds and Maintains Relationships : Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.

Communicates Effectively : Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.

Delivering Excellent Services : Serves Others with Compassion : Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.

Solves Complex Problems : Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.

Offers Meaningful Advice and Support : Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.

Ensuring High Quality : Performs Excellent Work : Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.

Ensures Continuous Improvement : Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.

Fulfills Safety and Regulatory Requirements : Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.

Managing Resources Effectively : Demonstrates Accountability : Demonstrates a sense of ownership, focusing on and driving critical issues to closure.

Stewards Organizational Resources : Applies understanding of the departmental work to effectively manage resources for a department / area.

Makes Data Driven Decisions : Demonstrates strong understanding of the information or data to identify and elevate opportunities.

Fosters Innovation : Generates New Ideas : Proactively identifies new ideas / opportunities from multiple sources or methods to improve processes beyond conventional approaches.

Applies Technology : Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.

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