Nurse Manager, Utilization Management

This is a remote position. The Nurse Manager (NM) is a Registered Nurse (RN) who is responsible for upholding excellence in the provision of Utilization Management (UM) Services through the implementation of the Profession Practice Model and UM regulatory standards. The NM is responsible for operational, human resources, quality, and financial management of UM responsibilities of OHSU Health. The NM is responsible for ensuring cost effective and quality patient care by appropriate utilization of resources and works with the interdisciplinary team to translate and implement organizational and division UM priorities into the unit’s operations. This includes managing programs for appropriate admissions, concurrent and retrospective review of care, compliance activities, denials/appeals management, and consultation of UM decisions and notification. The NM ensures a patient care environment that supports a safe, knowledgeable, compassionate, productive, with engaged staff in a remote setting. The NM partners with the interdisciplinary care team to ensure the delivery of safe, quality patient care and compliance with administrative, regulatory and clinical policies and procedures. The NM implements UM process improvement initiatives, ensures adherence to hospital and clinical standards of performance, bargaining unit agreements and human resource management. The NM collaborates with partner hospitals to provide UM services to those partner hospitals.