Nurse Manager Utilization Management

Job Summary

In addition to the responsibilities listed above, this position is also responsible for providing oversight of systems designed to monitor and ensure the quality care and services are provided at a comparable level to all members and patients across the continuum of care; coordinating efforts to resolve routine issues in quality improvement systems; aligning efforts to ensure that the organization meets the standards established by regulatory agencies and accreditation organizations and meets public expectations;

serving as a point of contact and expert on the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners; driving the utilization of systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education; leading the review and approval of medical staff or provider staff Bylaws, Rules and Regulations and amendments;

and maintaining oversight for systems of all contracted entities including but not limited to the Permanente Medical Groups. This role is also responsible for overseeing the peer review process, committees, and forums by managing the gathering of direct information on hospital or health system performance; aligning preliminary feedback across sources; and integrating feedback to develop a strategic development plan to address needs and solve problems.

• 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 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.
• Serves as the subject matter expert for clinical quality improvement processes and regulations within assigned teams, departments, and facilities by providing consultation on the interpretation and interaction of current policies and how they interact with the current climate, and potential changes to regulations and legislation; serving and leading on committees, projects to influence decisions on the enforcement, development of policies, or procedures of regulations and auditing processes and ensuring successful implementation of core priorities;
  
  fostering collaborative, results-oriented partnerships with practitioners, staff, and/or management across clinical and administrative roles to ensure credentialing regulations are followed and providing insight to the regulation climate; initiating the development of educational programs to raise awareness for current and changes in regulation requirement, internal concerns, and system/database usage; and empowering team to…