Under the direction of the Manager, functions as clinical resource for the Sr. Inpatient Utilization Management Nurses. Assesses training needs, assures policies and procedures are applied consistently by all members of the Inpatient Utilization Management team (IPUM). Responsibility to keep Manager up-to-date on day-to-day issues, meet with the Manager to discuss staffing, resource issues, performance issues, and assist with policy and process document development. Under the direction of the manager, functions as a resource for individual contributors and support staff (clinical). Acts as a subject matter expert and ensures consistency in procedures and workflows. Monitors operational reports and team compliance with requirements. Responsible to work with the department manager to ensure alignment with staffing, resource issues, performance issues, etc. as necessary.

Tasks and Essential Functions

• Functions as a resource to the IPUM team.
• Shares responsibility for training of new staff, including orientation.
• Provides ongoing guidance, oversight, and support of the team with regard to clinical review process, application of criteria, documentation, and care management system.
• Reviews cases sent for MD review and subsequent letters.
• Performs clinical admission reviews as needed to ensure timeliness.
• Oversees IPUM assignments to ensure timeliness, and reviews reports to identify trends and areas for improvement.
• Performs staff audits monthly.
• Assists with preparation for accreditation audits.
• Manages and provides increased support and oversight of high acuity sensitive cases as identified.
• Collaborates with CHNCT designees and departments as needed to identify areas of improvement and ensure streamlined workflow.
• Communicates with hospital/facility designees when needed to identify and resolve issues.
• Assists in various committees, work groups and taskforces as assigned.
• Conducts ad hoc meetings with staff as needed to discuss/develop new policies, processes, etc.
• Supports performance review process and provide input to staff annual evaluations.
• Works with staff to assure department metrics are met.
• Assesses and revises daily assignment.
• Provides oversight to staff and performs clinical review as needed to ensure timeliness metrics are met.
• Review cases sent for MD review and subsequent letters.
• Independently conducts comprehensive reviews of staff cases to identify opportunities to enhance performance, ensure documentation adheres to DSS and accreditation requirements.
• Recommends changes to workflows, processes, and procedures in order to streamline unit functions.
• Practices only within the boundaries of their competence, based on their education, training, appropriate professional experience, and other professional credentials.
• Monitors staff performance with an emphasis on compliance with contractual, regulatory, and URAC standards (as necessary).
• Manages overall performance and provides progressive discipline and positive recognition as appropriate.
• Evaluates and completes performance evaluations.
• Leads and motivates individuals; mentors subordinate staff and facilitates problem solving.
• Identifies and addresses training needs of staff.
• Schedules employees, including authorizing overtime; tracks attendance and timecard accuracy; projects staffing for daily and future (PTO) needs.
• Maintains regular contact with staff which includes regular one-on-one staff and other touch-base meetings.
• Assists in the evaluation of staff for conformity with policies and procedures, regulations, and professional standards.
• Ensures compliance with quality and safety regulations and standards.
• Monitors processes and procedures to recommend improvements.
• Recommends changes to workflows, processes, and procedures in order to improve efficiencies and streamline unit functions.