Utilization Manager Jobs in Wisconsin (NOW HIRING)

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 across the service line; 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 of self and/or team, 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.

• 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 continuum of care / care at home operations to support patient care by: providing additional oversight/span of control for, negotiating, and driving timelines for action item implementation and monitoring compliance to financial commitments; identifying, requesting, and implementing workflows and strategies to achieve performance targets and aligning with market strategies; developing and guiding short- and long-term operational initiatives and managing program, services, and/or systems; assuming accountability for human resource management related to performance measurement and employee management; directing continuous survey and compliance 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 contributing to the development, monitoring and control of departmental payroll and non-payroll budget and other aspects of financial management and cost control/reduction.
• Ensures standardized care delivery by: developing strategic partnerships with physicians and subject matter experts and service area leaders and overseeing highly complex workstreams with large program impact; leading the development and implementation of plans, policies, and processes for data gathering, using relevant data gathered, and analysis while ensuring guideline and regulation alignment; aligning patient care management solutions across departments and/or service lines, ensuring consistency and seamless transitions across the continuum of care; monitoring and/or managing resources as needed in clinical areas to ensure appropriate assignment and utilization; leading multidisciplinary continuum of care / care at home team(s) and holding team(s) accountable for performance; facilitating and leading local agency and outside provider contract/vendor relations to achieve optimal patient care and medical services for care across the continuum; assisting the design of emergency preparedness programs and ensuring the departments emergency preparedness and recovery plans are current and that managers and staff are trained and know what is expected during and after an emergency; and leading project teams, initiatives and monitoring implementation, equitable distribution of resources, and delivery on objectives.
• Manages improvements to operations and technology processes by: leading and implementing long-term strategic projects designed to remediate issues and improve 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 in response to barriers and/or issues; and ensuring performance metrics used to monitor the success of strategic improvement projects are tied to strategic organizational initiatives.

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Constructive Feedback
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Leadership
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Strategic Thinking
• Team Building
• Teamwork
• Topic-Specific Communication

• Emergency Preparedness
• Evidence-Based Medicine Principles
• Evidence-Based Practices
• Licensure Principles
• Nursing Principles
• Patient Safety
• Business Process Improvement
• Calendar Management
• Change Management
• Compliance Management
• Confidentiality
• Conflict Resolution
• Employee Training
• Employee/Labor Relations
• Financial Acumen
• Health Care Compliance
• Health Care Quality Standards
• Information Systems
• Legal And Regulatory Requirements
• Maintain Files and Records
• Member Service
• Microsoft Office
• Onboarding
• Outcome Driven Innovation
• Position Requirements
• Stakeholder Management
• Talent Management
• Training
• Union Work Environment
• Vendor Management
• Workforce Planning

• 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.
• Minimum three (3) years of customer or member/patient service experience.

This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.

• Registered Nurse License (Washington) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire
• Registered Nurse License (Oregon) within 6 months of hire
• Basic Life Support required at hire

• One (1) year of experience managing operational or project budgets.
• Three (3) years of project/program management and/or implementation-related experience.