Utilization Management Nurse Manager

Our mission is Better Health. Our passion is helping others.

What's Your Why?
• Are you looking for a career opportunity that will help you grow personally and professionally?
• Do you have a passion for helping others achieve Better Health?
• Are you ready to join a growing team that shares your mission?

Why Join Our Team: At Better Health Group, it's our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don't just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

Position Objective:

The Utilization Management (UM) Nurse Manager oversees and monitors the organization's UM functions. The goal is to achieve clinical, financial, and utilization goals by focusing on UM program performance and outcomes. The UM Nurse Manager manages daily UM operations of the UM Nurses. The incumbent will report to the Vice President, Health Services Operations.

Responsibilities:

• Lead and mentor a team of UM Nurses performing UM activities for Patients identified as having the need for Inpatient Care and/or Outpatient procedures, Inpatient Rehabilitation Facility or Long Term Acute Care Hospital (IPR/LTAC), Transplants, or Skilled Nursing Care, ensuring high UM program performance and quality outcomes of the Team
• Conduct regular audits and assessments of UM Nurses to ensure quality outcomes
• Track, monitor, and communicate trends in Key Performance Indicators and identify drivers and roadblocks to high-quality of care
• Collaborate with cross functional teams to identify and resolve challenges and coordinate activities
• Conduct regular meeting with internal and external stakeholders (e.g., payers, hospitals, SNFs, providers) to discuss UM improvement initiatives and progress
• Stay updated with industry regulations, guidelines, and best practices to ensure compliance and drive continuous improvement
• Responsible for obtaining EMR access to all the participating hospitals and maintaining relationships with all the hospitalist and hospitalist groups
• Assist with the preparation of department dashboards and reports
• Perform employee performance reviews
• Participate in the development and implementation of departmental Playbooks, and monitor/ensure compliance and consistency; review and revise workflows to ensure maximization of resources
• Other duties as assigned

• A bachelor's degree in Nursing or related medical field
• Proof of successful completion of educational requirements for a Nurse as defined by the state of Florida, as well as, proof of such licensure in good standing
• Licensure to be obtained for additional states or territories as required
• 3+ years of UM experience
• Complex Case Management (CCM) certification is a plus

• Minimum of 2 years leadership/management experience
• Proven success working with interdisciplinary teams
• Proficient with Google Suite (Drive, Docs, Sheets, Slides) and Microsoft Office (Word, Excel, PowerPoint) for real-time collaboration

• Ability to remain in a stationary position, often standing or sitting for prolonged periods of time
• Communicating with others to exchange information
• Repeating motions that may include the wrist, hands, and/or fingers
• Must be able to lift at least 15 lbs at times
• Ability to operate a motor vehicle

• Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals
• Demonstrated ability to handle data with confidentiality
• Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision
• Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
• Excellent written and verbal communication skills; must be comfortable communicating with senior-level leadership, providers, and health plans
• Strong interpersonal and presentation skills
• Strong critical thinking and problem-solving skills
• Must be results-oriented with a focus on quality execution and delivery
• Appreciation of cultural diversity and sensitivity toward target patient populations