Manager, Utilization Management - Vanderbilt Clarksville Hospital (RN required) - REMOTE

Vanderbilt University Medical Center•Nashville, TN

3d•Remote

About The Position

Manager within the Utilization Management department at VUMC will be responsible for the growth and development of the team, operations and implementation of successful processes to best support enterprise growth and Utilization Management functions.

Requirements

LIC-Registered Nurse - Licensure-Others
Relevant Work Experience
3 years
Master's

Responsibilities

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