Utilization Manager, Manager DUHS

Functions as a departmental subject matter expert.

In conjunction with the Team Leaders, the Manager will assess the daily census assignment ensuring acuity and caseloads are equitable.

Provides hands-on support for critical staffing needs.

Monitors productivity.

Partners with CM Director, Assistant Directors and Managers in conducting leadership rounds to support workflow and staff engagement.

Development and oversight of UM work schedules/calendar management via API in accordance with the PTO policy.

Ensure adherence to all Case Management Department and DUHS organizational policies.

Ensures adherence to regulatory compliance.

Promotes an environment of interdepartmental, health system and post- acute care collaboration.

 Attends and contributes to the Utilization Management Committee meeting.

Will participate in the development and presentation of projects and education topics to designated departments, provider groups, clinical service units and community collaborators as indicated.

Collaboration with CSU leadership on continuous process improvement

In collaboration with the Directors and Human Resources, manages the recruitment, hiring, onboarding and retention of Case Management Department staff.

Will conduct employee 30/60/90 day evaluations as well as mid-year and end of year evaluations.

In conjunction with the Director, maintains employee Human Resource and secondary files in accordance to Joint Commission and DUHS guidelines.

Ensures compliance with licensure and certification requirements of new and existing employees.

In conjunction with TLs, will support daily patient flow huddles.

Provides education to support regulatory compliance in collaboration with DUHS Compliance and CM Department leadership.

Conducts Utilization Management Divisional Meetings.

Provide education and feedback to provider groups as indicated

Monitors monthly reporting including but not limited to UM productivity, Readmission Documentation, Initial Time to Review, Avoidable Days Documentation, Denials Management and Discharge Appeals processes. Collaborates with the Directors and Team Leads regarding outcomes.

Works with the Physician Advisors and Medical Directors on escalation of care and process improvement activities including but not limited to LOSM, readmissions, avoidable days, denial management, problem solving and education needs.

Participates in the review and updating of Case Management policies. - Escalates and keeps Directors informed of workflow or personnel concerns.