Current Registered Nurse license in Rhode Island or Nurse Licensure Compact agreement.
Bachelor's degree in nursing required; Master's preferred.
Five years of clinical/utilization management experience with leadership skills.
Strong written and oral communication abilities.
Knowledge of utilization review criteria; case management certification preferred.
Responsibilities
Lead and mentor utilization management nurses and preauthorization staff.
Develop and implement staff competency evaluations and orientation programs.
Act as a resource for utilization managers and support staff.
Create departmental policies and strategic plans.
Manage departmental budgets and ensure resource allocation aligns with goals.
Provide on-call support for utilization management nurses during weekends and holidays.
Benefits
Opportunities for continuing education and professional development.
Supportive work environment focused on patient-centered care.
Involvement in strategic planning and policy development.
Leadership role with significant impact on departmental operations.
Full Job Description
SUMMARY:
Under the general direction of the Director Utilization Management, provides leadership for utilization management nurses, payor liaison/utilization management specialists and preauthorization staff assigned to the utilization management department. Participates in the design, development, implementation and improvement of the utilization management model at Brown University Health. Fosters patient and family centered care in accordance with the Brown University Health mission, vision and values.
RESPONSIBILITIES:
Provides for leadership of utilization management nurses, payor liaisons and other preauthorization staff including orientation, continuing education, and competency assessment. Participates in the interviewing process. Recommends selection of staff, direct activities and evaluates professional and support staff to optimize achievement of goals and objectives.
In collaboration with the Director of Utilization Management develops measurements for evaluating staff competencies and orientation.
Acts as a resource to utilization managers and payor liaisons and support staff. Develops departmental policies and strategic plans.
In collaboration with the director utilization management and the medical director of utilization management identifies institutional needs and determines priorities.
Develops, analyzes and adheres to departmental and capital and operating budgets, ensuring appropriate staffing and resources are in place to support utilization management standards of practice.
Provides for the effective utilization of resources (people, financial, material and equipment) to meet established goals and objectives.
Responsible to be an on-call resource to all system utilization management nurses on rotating weekend and holidays
PERFORMANCE STANDARDS:
Effective utilization of resources
Management of continuous quality improvement
High quality, high value patient-focused services
Resource productivity
Fiscal responsibility
Development and implementation of effective quality programs
Customer satisfaction
Performance improvements year-to-year
Positive feedback from peers, direct reports and staff
MINIMUM QUALIFICATIONS:
Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.
QUALIFICATIONS - EDUCATION:
Must have a current license to practice as a registered nurse in the State of Rhode Island.
Bachelor's degree in nursing required.
Master's degree in nursing or other health discipline preferred.
Understands the provisions of the Nurse Practice act of the State of Rhode Island.
Certification in case management preferred.
QUALIFICATIONS - EXPERIENCE:
Five years relevant clinical/utilization management experience with demonstrated leadership skills.
Experience should demonstrate a high level of written and oral communication skills.
Knowledge of utilization review criteria.
Previous case management/utilization management leadership experience is highly desirable
SUPERVISION:
Management responsibility for up to 40 FTEs.
Pay Range: $97,718.40-$195,436.80
Location: Rhode Island Hospital - 593 Eddy Street Providence, Rhode Island 02903 Work Type: M-F 730-4PM Work Shift: Day Daily Hours: 8 hours Driving Required: No
