Utilization Management Nurse Manager 2 - Hospital

In addition to the responsibilities below, this position is also responsible for leading the implementation of best practice models; leading the implementation of patient care delivery systems and practice standards in several locations; delegating tasks related to the investigation and resolution of patient/family/member concerns regarding patient care and services; facilitating collaboration with physicians, outside healthcare providers, and other health care team members to achieve optimal and safe patient care across the continuum; proactively monitoring resource needs in several clinical areas to ensure appropriate assignment and utilization; managing the use and maintenance of equipment, supplies and medications; ensuring a safe environment for patients and employees; maintaining clinical expertise, 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. Collaborates with Nursing Clinical Practice to ensure assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal, state, and local requirements. Note\: Depending on assignment, this position may require technical or supervisory experience in one or more specialty areas, including but not limited to Operating Room/Procedure Suite, Emergency Services, Critical Care, Maternal Child Health, etc.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams 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; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Manages hospital administrative functions to support patient care by\: negotiating timelines for action item implementation and monitoring compliance to financial commitments; developing and implementing ad hoc reports that capture workflows and developing strategies to achieve performance targets; developing and guiding short- and long-term operational initiatives, and managing program, services, and/or systems; assuming accountability for activities across functions including workplace and patient safety, human resources (e.g., recruitment, selection, promoting active recruitment, performance evaluation and management), labor relations, training and development, and quality/risk management issues; designing continuous survey 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 leading in the development, monitoring, and control of departmental payroll and non-payroll budget and other aspects of financial management and cost control/reduction.
• Manages care delivery operations and programs within a twenty-four-hours-a-day, seven-days-a-week operational environment by\: developing strategic partnerships with physicians, subject matter experts, and service area leaders, and overseeing highly complex work steams with large program impact; leading the development and implementation of plans, policies, and processes for data-gathering and analysis while ensuring alignment with guidelines and regulations; aligning direct and/or indirect patient care management solutions across departments; managing resources in hospital areas to ensure appropriate assignment and utilization; leading multidisciplinary hospital team(s) and holding team(s) accountable for performance; assisting the design of emergency preparedness programs; ensuring the departments emergency preparedness and recovery plans are current, ensuring managers and staff are trained and understand expectations for during and after an emergency; leading project teams and/or initiatives and monitoring implementation, equitable distribution of resources, and delivery on objectives; and leading teams responsible for the delivery of nursing services and patient care within a twenty-four-hours-a-day, seven-days-a-week operational environment in alignment with cost, quality, and clinical and utilization standards.
• Manages improvements to operations and technology processes by\: leading and implementing long-term cross-functional strategic projects designed to achieve goals related to issue remediation and improved quality, service, affordability, and/or operating efficiency; developing and managing a structured approach for identifying root causes and implementing solutions to improve the performance of operations system processes and address quality and safety issues; collaborating with senior leadership on the development of strategic plans with the goal of achieving integrated services across the continuum of care; and ensuring performance metrics used to monitor the success of strategic improvement projects are tied to strategic organizational initiatives.
• Ensures safe, quality, and standardized care delivery within a twenty-four-hours-a-day, seven-days-a-week operational environment by\: driving the continuous improvement of the quality and safety of clinical practices, services, and operations for patients and staff; holding staff and direct reports accountable for maintaining compliance with legal and regulatory requirements (e.g., Nursing Practice Act, The Joint Commission [TJC], federal, state, and local requirements) updated by governmental and regulatory agencies; and leading the design and implementation of systems, processes, and methods to evaluate and improve patient care within assigned department and across the continuum of care.

In addition to the responsibilities below, this position is also responsible for leading the implementation of best practice models; leading the implementation of patient care delivery systems and practice standards in several locations; delegating tasks related to the investigation and resolution of patient/family/member concerns regarding patient care and services; facilitating collaboration with physicians, outside healthcare providers, and other health care team members to achieve optimal and safe patient care across the continuum; proactively monitoring resource needs in several clinical areas to ensure appropriate assignment and utilization; managing the use and maintenance of equipment, supplies and medications; ensuring a safe environment for patients and employees; maintaining clinical expertise, 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. Collaborates with Nursing Clinical Practice to ensure assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal, state, and local requirements. Note\: Depending on assignment, this position may require technical or supervisory experience in one or more specialty areas, including but not limited to Operating Room/Procedure Suite, Emergency Services, Critical Care, Maternal Child Health, etc.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams 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; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Manages hospital administrative functions to support patient care by\: negotiating timelines for action item implementation and monitoring compliance to financial commitments; developing and implementing ad hoc reports that capture workflows and developing strategies to achieve performance targets; developing and guiding short- and long-term operational initiatives, and managing program, services, and/or systems; assuming accountability for activities across functions including workplace and patient safety, human resources (e.g., recruitment, selection, promoting active recruitment, performance evaluation and management), labor relations, training and development, and quality/risk management issues; designing continuous survey 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 leading in the development, monitoring, and control of departmental payroll and non-payroll budget and other aspects of financial management and cost control/reduction.
• Manages care delivery operations and programs within a twenty-four-hours-a-day, seven-days-a-week operational environment by\: developing strategic partnerships with physicians, subject matter experts, and service area leaders, and overseeing highly complex work steams with large program impact; leading the development and implementation of plans, policies, and processes for data-gathering and analysis while ensuring alignment with guidelines and regulations; aligning direct and/or indirect patient care management solutions across departments; managing resources in hospital areas to ensure appropriate assignment and utilization; leading multidisciplinary hospital team(s) and holding team(s) accountable for performance; assisting the design of emergency preparedness programs; ensuring the departments emergency preparedness and recovery plans are current, ensuring managers and staff are trained and understand expectations for during and after an emergency; leading project teams and/or initiatives and monitoring implementation, equitable distribution of resources, and delivery on objectives; and leading teams responsible for the delivery of nursing services and patient care within a twenty-four-hours-a-day, seven-days-a-week operational environment in alignment with cost, quality, and clinical and utilization standards.
• Manages improvements to operations and technology processes by\: leading and implementing long-term cross-functional strategic projects designed to achieve goals related to issue remediation and improved quality, service, affordability, and/or operating efficiency; developing and managing a structured approach for identifying root causes and implementing solutions to improve the performance of operations system processes and address quality and safety issues; collaborating with senior leadership on the development of strategic plans with the goal of achieving integrated services across the continuum of care; and ensuring performance metrics used to monitor the success of strategic improvement projects are tied to strategic organizational initiatives.
• Ensures safe, quality, and standardized care delivery within a twenty-four-hours-a-day, seven-days-a-week operational environment by\: driving the continuous improvement of the quality and safety of clinical practices, services, and operations for patients and staff; holding staff and direct reports accountable for maintaining compliance with legal and regulatory requirements (e.g., Nursing Practice Act, The Joint Commission [TJC], federal, state, and local requirements) updated by governmental and regulatory agencies; and leading the design and implementation of systems, processes, and methods to evaluate and improve patient care within assigned department and across the continuum of care.

• Minimum five (5) years of experience in patient care delivery.
• Bachelors degree in Nursing (BSN) AND minimum five (5) years of experience in business operations, clinical health care, or a directly related field.
• Minimum four (4) years of experience in a leadership role with or without direct reports.

• Basic Life Support required at hire

• Registered Nurse License (California) required at hire

• Minimum five (5) years of experience in patient care delivery.
• Bachelors degree in Nursing (BSN) AND minimum five (5) years of experience in business operations, clinical health care, or a directly related field.
• Minimum four (4) years of experience in a leadership role with or without direct reports.

• Basic Life Support required at hire

• Registered Nurse License (California) required at hire

• Pediatric Advanced Life Support (PALS) certification from the American Heart Association.
• Certification from the American Nurses Credentialing Center (ANCC) in related practice area.

• Pediatric Advanced Life Support (PALS) certification from the American Heart Association.
• Certification from the American Nurses Credentialing Center (ANCC) in related practice area.

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