Manager of Utilization Management | Full Time

The Manager of Utilization Management oversees the day to day operations of the Utilization management department and the Utilization management staff. Oversees utilization review for UF Health St. Johns, ensuring appropriate utilization of resources for all patients - inpatient, observation and outpatients. Reports to the VP of Revenue Cycle

• Responsible for the day-to-day Utilization management operation for the hospital.
• Oversees all Utilization management duties and assures appropriate staff coverage for the department.
• Serves as a key leader in supporting and ensuring hospital and medical staff compliance with regulatory requirements from government payers.
• Interacts with managed care payers to ensure appropriate utilization of resources for managed care patients.
• Develops and effectively uses measurable standards to monitor and evaluate cost-effective utilization of resources in the delivery of care.
• Compiles reports, analyzes data, and identifies trends in medical utilization data, such as resource use per case, denials, avoidable days, LOS, re-admissions, denials, and clinical outcomes.
• Designs, plans and implements the staff orientation programs. Identifies on-going educational needs and opportunities for staff, based on the requirements of their positions and specific needs of the individual.
• Provides personal mentorship on a regular basis to all Utilization management team members to promote their professional growth.
• Identifies new areas/opportunities for improvement within assigned operating unit.
• Works collaboratively with medical staff, administrative leadership and nursing leadership to ensure optimum achievement of Utilization management targets.
• Works collaboratively, in a dyad model, with the physician advisor(s).
• Prepares and distributes monthly reports on outcomes and case management targets.

Required experience:

• 5 years Critical Care nursing experience
• 3 years Case Management and/or Utilization Management experience

Required education:

• Associates degree in Nursing

Required Licensing:

• Active FL RN License

Case management or Utilization Review certification preferred