Nurse Manager I, Utilization Management

SIGN ON BONUS OF $10,000 AVAILABLE TO ELIGIBLE EXTERNAL HIRES!

Job Summary :

In addition to the responsibilities below, this position is also responsible for implementing best practice models; implementing patient care delivery systems and practice standards in one or more locations; investigating and resolving patient / family / member concerns regarding patient care and services; collaborating with physicians, outside healthcare providers, and other health care team members to achieve optimal and safe patient care across the continuum; monitoring resource needs in assigned clinical areas to ensure appropriate assignment and utilization; monitoring the use and maintenance of equipment, supplies and medications; fostering a safe environment for patients and employees; maintaining clinical expertise of self and / or team, 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 :

Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.

Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.

Manages continuum of care / care at home operations to support patient care by : driving implementation of action items and supporting compliance with timelines and financial commitments; using and providing feedback on standard reports and identifying needed ad hoc reporting to meet specific client needs related to workflow and performance targets; providing feedback as needed on data collection, reviewing data, and translating reports into short-term operational initiatives; managing human resources activities related to recruitment, creating and ensuring the use of standardized procedures and processes for employee management; leading survey and compliance readiness activities, including mock rounds and mitigating issues, to maintain compliance and regulatory standards and developing procedures for preparing audit documentation, information, and reports; and assisting in the development and management of their departments expenditures, payroll, and non-payroll budget with input from a higher-level leader.

Ensures standardized care delivery by : developing strategic partnerships with physicians and subject matter experts and managing complex work streams and implementing strategic initiatives with significant program impact; using data and analysis to ensure strategic alignment while developing and implementing plans; proactively monitoring and managing daily operational activities involving patient care management, ensuring consistency and seamless transitions across the continuum of care; managing resources in clinical areas to ensure appropriate assignment and utilization; managing multidisciplinary continuum of care / care at home team(s); supports managing local agency and outside provider contract / vendor relations that provide optimal patient care and medical services for care across the continuum; implementing emergency preparedness programs and ensuring the teams emergency preparedness and recovery plans are current and that staff are trained and know what is expected during and after an emergency; and leading project teams, initiatives and monitoring implementation and delivery on objectives.

Manages improvements to operations and technology processes by : defining issues and overseeing the development of goals and priorities for strategic projects designed to remediate issues and improve quality, service, affordability, and / or operating efficiency; applying a structured approach for identifying root causes and implementing solutions to improve the performance of operations system processes; and ensuring performance metrics used to monitor the success of strategic improvement projects are tied to strategic department initiatives.

Minimum Qualifications :

Bachelors degree in Nursing (BSN) AND minimum three (3) years of experience in business operations, clinical health care, or a directly related field.

Minimum two (2) years of experience in a leadership role with or without direct reports.

Minimum two (2) years of customer or member / patient service experience.

Registered Professional Nurse License (Georgia) required at hire

Basic Life Support required at hire

Additional Requirements :

Knowledge, Skills, and Abilities (KSAs) : Evidence-Based Medicine Principles; Evidence-Based Practices; Compliance Management; Confidentiality; Member Service; Conflict Resolution; Stakeholder Management; Legal And Regulatory Requirements; Microsoft Office; Health Care Quality Standards; Information Systems