Job Description
Job Description
Description :
The Nurse UM Director is responsible for overseeing and directing the Utilization Management and Quality Improvement programs within the healthcare organization. This role ensures that the highest standards of patient care are met while optimizing resource utilization and maintaining compliance with regulatory requirements. The Nurse UMQI Director collaborates with medical staff, nursing staff, and administrative leaders to develop and implement strategies that enhance patient outcomes and operational efficiency.
This position reports to the Chief Medical Officer (CMO), and is part of the Utilization Management and Quality Improvement department.
Responsibilities :
Leadership and Management :
- Lead and manage the UMQI department, including hiring, training, and evaluating staff.
- Develop and implement policies and procedures to ensure effective utilization management and quality improvement.
- Provide guidance and support to staff in the execution of UMQI activities.
Utilization Management :
Oversee the review of patient care services to ensure appropriate utilization of resources.Monitor and analyze utilization data to identify trends and areas for improvement.Collaborate with delegated entities (physician groups) to develop and implement utilization management strategies.Quality Improvement :
Lead quality improvement initiatives to enhance patient care and safety.Develop and implement quality improvement plans and projects.Monitor and evaluate the effectiveness of quality improvement activities.Compliance and Reporting :
Ensure compliance with all relevant regulatory and accreditation standards.Prepare and submit reports to regulatory agencies and internal stakeholders.Stay current with changes in regulations and standards affecting UMQI activities.Collaboration and Communication :
Foster a collaborative environment with medical staff, nursing staff, and other departments.Communicate effectively with all levels of the organization to promote UMQI goals and initiatives.Assist other departments when appropriate and available.Represent the UMQI department in meetings and committees at appropriate levels.Ability to travel as needed.Special projects as assigned.Requirements :
Minimum Qualifications
Bachelor’s degree in nursing (BSN) preferredNursing degree requiredStrong leadership and management skillsExcellent communication and interpersonal skillsAnalytical and problem-solving abilitiesKnowledge of regulatory and accreditation standardsLicenses / Certifications :
Current RN license (any state)Professional Competencies
Minimum of previous 2 years of previous clinical nursing experienceMinimum of 5 years of experience in utilization managementPrevious leadership experience in a healthcare settingPrevious health plan experience strongly preferredVerda cares deeply about the future, growth, and well-being of its employees. Join our team today!
Job Type : Full-time
Onsite : 100% onsite
Benefits :
401(k)Paid time offHealth insuranceDental InsuranceVision insuranceLife insuranceSchedule :
Full-time onsiteStandard business hours Monday to Friday / weekends as neededOccasional travel may be required for meetings and training sessions.Ability to commute / relocate :
Reliably commute or planning to relocate before starting work (Required)PHYSICAL DEMANDS
Regularly sit / walk at a workstation in an office or cubicle setting. Must occasionally lift and / or move up to 25-50 pounds.
Other duties may be assigned in support of departmental goals.
