Manager, Utilization Management

Job Description
General Summary
Assume 24-hour accountability for managing the functions of Utilization
Management. With the Manager of Case Management and the Manager of Social Work, serves as the central resource to the Director of Care Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement.
To meet accountabilities of the Care Management Dashboard collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all duties.
Direct oversight of the Utilization Management Lead (s) and frontline Utilization Review staff.
Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested. Develops a growth plan for each employee.
Manages hiring and performance management of staff.
Keeps key statistics and participates in the maintenance of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
Manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
Manages structure and process to facilitate participation by physicians, rehabilitation, pastoral care, care coordinators, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
Participates and fosters performance improvement within the department and organizationally.
Oversees operational budget
Partners with physicians and the Physician Advisor (s) for effective relationships with physicians, services, specialties, etc.
Establishes collaborative relationships with owner of hospital contracts and reimbursement.
Participate in payer, Revenue Management Cycle and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to utilization management.
1Serves as educational and communications resource to Administration, Department Leadership, physicians and other necessary groups regarding the utilization review/management activity process.
Maintains a leadership role in the Utilization Committee and Plan as it relates to the conditions of participation.