Registered Nurse (RN) Manager - Utilization Review - Full-Time / Day

Role Overview: Leading and managing all aspects of the Utilization Management (UM) program, ensuring compliance with regulatory standards, and delivering high-quality patient care. The role involves overseeing program operations from admission to discharge, collaborating with physicians and hospital departments, and maintaining evidence-based practices. Responsibilities Utilization Review: Coordinating care across the continuum, analyzing reports, ensuring compliance, and serving as a liaison between clinical departments.Customer and Employee Satisfaction: Promoting a positive environment, responding to inquiries, fostering teamwork, and developing departmental goals and initiatives.Patient Care Coordination: Assessing current trends, updating standards, overseeing daily operations, and consulting with healthcare providers to optimize patient outcomes.Education and Outcomes Management: Developing educational materials, facilitating staff development, tracking data, and identifying improvement opportunities.Fiscal Accountability: Assisting in budget development, managing resources within budget, and promoting cost-effective utilization services.Regulatory Compliance: Ensuring adherence to standards, developing professional protocols, monitoring staff compliance, and participating in relevant committees. Qualifications & Skills: Leadership in healthcare management, expertise in utilization review processes, regulatory knowledge (e.g., CMS, Joint Commission), strong communication and collaboration skills, data analysis capabilities, and a focus on quality improvement and staff development.