Registered Nurse Manager - Utilization Review & Case Management

Registered Nurse Manager - Utilization Review & Case Management

This job involves managing the daily operations of the Utilization Management Program in a Medical Center or Service Area, ensuring cost-effective and quality patient care through proper resource utilization. The role supports Case Management in an acute care hospital setting, focusing on patient movement through different levels of care and ensuring appropriate discharges and follow-up at home.

Notes: This position requires rotating on-call duties after hours, including weekends and holidays.

Employee Status: Regular

Travel: Yes, approximately 20%

Job Level: Manager with Direct Reports

Job Type: Standard

Additional Compensation: Up to 15% annual incentive

Direct Reports: Yes

Essential Responsibilities

• Developing and maintaining policies related to Utilization Management
• Collaborating with multidisciplinary teams to coordinate care
• Managing care across external facilities and providers, identifying risk and quality issues
• Addressing issues and suggestions with team members
• Managing transportation to meet healthcare guidelines and patient needs
• Ensuring compliance with regulatory standards
• Providing staff direction in utilization review, care coordination, and discharge planning
• Conducting statistical analysis on utilization trends and outcomes
• Hiring, training, coaching, and disciplining staff

Basic Qualifications

• At least three years of experience in utilization management and discharge planning in an acute care setting, including supervisory or management roles
• Three years of case management experience with leadership responsibilities
• BSN or related healthcare degree
• Registered Nurse License (California)

Preferred Skills

• Certified Case Manager
• Master's Degree
• Management experience in a union environment
• Experience in high-volume hospital settings

Additional Requirements

• Knowledge of healthcare operations, regulations, and managed care
• Strong interpersonal, negotiation, and management skills
• Excellent communication skills
• Ability to work in a Labor/Management Partnership environment