Utilization Management Manager

Title: Care Management Manager
Department/Location: Care Management
Reports to: Administrative Director, Care Management

Position Summary

Assures the delivery of quality services in accordance with established hospital, departmental, and regulatory/accreditation agency standards.

Is responsible and accountable for the overall operations of their assigned department, in conjunction with the UM manager and the department Director. Overall operations of the department include quality assurance and PI plan, development of department goals and objectives that are consistent with the hospital mission, the management of personnel, preparing/monitoring of and accountability for the department budgets.

Assures employee compliance with hospital, nursing department, and Human Resources policies and procedures.

Assures that employee orientation, skill competency, and continuing education requirements are satisfied, as per regulatory requirements – government, state, hospital, and department policies/regulations.

Participates in the hospital Performance Improvement Program, as defined by the organization, and sets up department PI plan based on regulatory requirements, as needed. Follows up on outliers and areas identified as needing improvement.

Is responsible for participation on committees, task forces, and projects as appropriate and required.

Assures the provision of a safe employee/patient environment and follows up on all staff incidents and safety issues. Maintains knowledge and continuing education related to the operations and needs of the department.

Works collaboratively with all levels of the hospital interdisciplinary team and promotes the team concepts, effective communication, and cooperative spirit, within the department and hospital-wide departments.

Demonstrates positive customer service skills, fosters positive employee relations, and assures staff adherence to the Customer Service Behavioral Standards.

Is supportive of hospital initiatives and projects and functions. Serves as a role model and a positive change agent.

Promotes a positive and professional image and behaviors. Serves as a coach and mentor and provides necessary resources to staff, peers, and patients as needed.

Establishes and maintains good working relationships with community agencies and facilities. Develops ways of getting monthly information from them regarding stats and outcomes, to ensure our patients are receiving the best possible care after transition and discharge.

Has a working knowledge of Medicare and Medicaid guidelines and regulatory requirements/parameters, to ensure compliance. Has an understanding of HMOs operations and other private health insurances.

Essential Functions and Responsibilities Includes the Following:

• Understands and adheres to the WPH Performance Standards, Policies, and Behaviors
• Develops and submits departmental goals and objectives as required by the Division Administrator on an annual basis.
• Interviews, recommends hires, evaluates, counsels, and recommends terminations of employees, as per hospital policy and departmental needs.
• Schedules staff based on budgeted staffing plan and hospital needs, ensuring adequate coverage for safe patient care to prevent delays in discharge.
• Develops and submits operating and capital budgets and reports variances on a monthly basis, as required by the department director.
• Assures compliance with state regulations and accreditation standards.
• Assures completion of staff orientation, annual and ongoing competency and education requirements. Summarizes monthly PI studies done by the staff and recommends actions for improvement.
• Attends and participates in continuing education programs and other related activities to maintain current level of skills and expertise to manage the department, in conjunction with the UM manager and department director.
• Participates and assures department involvement in ongoing Performance Improvement initiative. Submits monthly reports as required.
• Attends Management/Leadership meetings as required.
• Conducts staff meetings, in the absence of the director, to update staff and/or address department issues and ensures meeting minutes are being taken and kept for all staff and future reference.
• Utilizes multiple methodologies to communicate information, ensuring follow-up and understanding of all levels of staff members.
• Adheres to safety standards for employees and patients.
• Participates in committees, task forces, projects, etc., as required.
• Performs all other related duties as assigned.

Education & Experience Requirements:

• Bachelor’s Degree in Nursing with RN License required, Master’s Degree in Nursing preferred
• 5 years managerial experience within the acute hospital
• Previous experience as a case manager required
• Knowledge of healthcare financial, regulatory, and payer issues in the healthcare setting required
• Knowledge of state, local, and federal programs required
• Experience with Millimen/Interqual criteria required
• PRI/Screen certification preferred
• C.C.M. certification preferred
• Computer skills required

Core Competencies

• Demonstrates ability to establish two-way communication by clearly defining expectations and functions, based on regulatory requirements and hospital policies.
• Communicating with the staff, utilizing a variety of methods, and actively listening to ideas and concerns and responding in an appropriate manner.
• Demonstrates ability to delegate responsibilities appropriately. Demonstrates ability to retain composure under stress.
• Escalates issues to the director as soon as they occur, to come up with joint resolutions for safe care and interventions.

Physical/Mental Demands/Requirements & Work Environment

• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) database and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.
• Must be physically able to move quickly throughout the work environment and the hospital. Must be able to utilize a computer with Microsoft Office experience. Must be able to read and write, using analytical skills to interpret data and make necessary conclusions and recommendations.
• Demonstrates ability to follow written and oral instructions required for the position.
• Demonstrates ability to analyze multidimensional problems and tasks into manageable components and sort out actions/plans in order of priorities to solve the problem/issues.
• Must be able to communicate with patients and others in a caring, sensitive, and warm manner and help the staff to visually assess a patient’s affect and body language.

#4009

Job Type: Full-time

Pay: $120,000.00 - $140,000.00 per year

Schedule:

• 8 hour shift
• Day shift
• Night shift

Ability to Relocate:

• White Plains, NY 10601: Relocate before starting work (Required)

Work Location: In person

Salary : $120,000 - $140,000