Manager, Utilization Management; RN - REMOTE

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Utilization Management

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…