Nurse Manager, Utilization Management

OHSU Health • Full-time • Portland, OR, US • 1w ago

Department Overview

The NM’s decisions and actions are based on the ethical principles outlined by the American Nurses Association’s Code of Ethics for Nursing. The NM practices in adherence with the American Nurses Association’s (ANA) Nursing Administration: Scope and Standards of Practice for Nurse Administrators, the ANA Code of Ethics for Nursing, the Oregon State Board of Nursing’s Nurse Practice Act, and within the context of the Nurse Executive Competencies developed by the American Organization of Nurse Executives (AONE). The NM exemplifies the principles of the OHSU Culture of Safety Position Statement by committing to a Just Culture, a Reporting Culture, a Learning Culture, and an Engaged Informed Culture.

Function/Duties of 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.

Required Qualifications

BSN or higher degree in nursing.

And

Master’s degree in nursing or related field, or in process

Five years of experience as a registered nurse in a related specialty

And

Two years recent related management/leadership experience.

Professional certification in nursing leadership-Nurse Executive/Administrator within 3 years of assuming the manager role.

Experience in complex organization environments.

Ability to effectively manage multiple conflicting priorities.

Proficient with word processing, computational spreadsheet (e.g., Excel), and presentation software.

Unclassified

Additional Details

Comprehensive health care plans. Covered 100% for full-time employees and 88% for dependents for .9 FTE and higher.
$25K of term life insurance provided at no cost to the employee
Two separate above market pension plans to choose from
Paid time off- 208 hours per year (full-time), prorated for part-time
Extended illness bank- 64 hours per year, prorated for part-time
9 paid holidays per year
Three weeks of paid parental leave
Adoption assistance program (up to 5k)
Substantial Tri-met and C-Tran discounts
Tuition Reimbursement
Innovative Employee Assistance Program (EAP)

All are welcome

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.

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