JOB SUMMARY: Manages front line staff members of Utilization Management department and actively participates in supporting management functions including staff development and evaluation of clinical practice. Develops and maintains standards of practice in accordance with evolving practice of utilization management. Trends and reports revenue cycle and utilization management metrics to ensure optimal performance. Effectively utilizes department leadership to intervene with complex cases and additional needs. Serves as resource to utilization management staff to facilitate complex cases needs, educational needs, and escalate concerns and feedback to appropriate leadership.
Ensures the department's optimal performance among their team by engaging in effective problem solving with inter professional staff, clinicians, patients and families.
Responsible for team accountability to performance standards including quality, service, patient flow, communication and credo behavior. Interacts effectively with members of the health care team and ancillary departments to monitor and achieve quality patient outcomes.
Supports the delivery of quality patient care by holding staff accountable to established patient care and regulatory standards.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
OPERATIONS PLANNING - (INTERMEDIATE): - Demonstrates ability to forecast complex resource needs, identify discrete tasks, set priorities, define dependencies, schedule activities, meet deadlines, and organize work for a single functional area. Merges diverse points of view into a coalition with shared goals and objectives. Plans for and anticipates events outside of immediate responsibility. Identifies relevant stakeholders and gains their commitment. Anticipates problems and obstacles before they arise. Able to absorb changes to major assignments while maintaining a high level of performance. Competently handles multiple assignments and projects simultaneously. Sets priorities with a proper sense of urgency and importance. Develops creative ideas and takes innovative action to achieve planned goals and objectives.
PEOPLE MANAGEMENT - (INTERMEDIATE): - Successfully resolves conflicts and disciplinary problems. Provides counseling and career development planning to subordinates. Constructively gives timely positive and negative feedback, confronting individual performance problems in a professional and sensitive manner. Aware of the values, abilities and needs of others. Demonstrates the ability to create a positive work climate, establishing a feeling of partnership and empowering others. Has set, coached and assessed the assignment objectives of subordinates. Practices and rewards behaviors supportive of company values.
COMPLIANCE - (INTERMEDIATE): - Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them.
BUSINESS RESULTS - (NOVICE): - Develops and implements appropriate measures for attaining well-defined business results and tracks progress in meeting goals and objectives. Continuously demonstrates a strong focus on quality in spite of pressures from competition, budgets, and time. Anticipates and responds effectively to customer needs. Sensitive to changes in the environment which may impact customer satisfaction, product quality, or profitability. Able to specify clear, precise personal objectives.
QUALITY MANAGEMENT (NOVICE): - Developing a systematic process of checking to see whether a process or service is meeting specific requirements.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.