Harris Health System - Southwest Houston, TX
posted 18 days ago
Full-time - Manager
Remote - Southwest Houston, TX
Ambulatory Health Care Services
About the position
The Manager of Utilization Management (MUM) is responsible for coordinating the design, development, implementation, and monitoring of utilization management functions within the Harris Health System. This role aims to achieve clinical, financial, and utilization goals through effective management and communication. The MUM oversees interdisciplinary processes across the continuum of care, develops strategic business initiatives, and leads process improvement projects to enhance integrated care delivery. The position requires collaboration with various teams and the authority to make operational decisions consistent with organizational policies.
Responsibilities
- Coordinate the design, development, implementation, and monitoring of utilization management functions.
- Oversee the coordination of services through an interdisciplinary process across the continuum of care.
- Develop and lead strategic business initiatives and programs as assigned.
- Balance patient needs with cost-effective utilization of resources.
- Lead process improvement projects to enhance integrated care delivery.
- Plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives.
- Manage day-to-day tasks, activities, and caseloads for UM Nurses and resources assigned to the program.
- Foster collaborative relationships with peers, co-workers, and staff.
- Develop processes for streamlined communication with third-party payers.
Requirements
- Graduated from an accredited school of Nursing with a Bachelor's in Nursing.
- Master's Degree in nursing, business, health administration, public health, social work, or a healthcare-related field.
- Registered Nurse: Licensed to practice nursing in the State of Texas.
- Case Management Certification (ACM or CCM) within two years of hire.
- Basic Life Support certification from American Heart Association (AHA) or Red Cross approved program.
- 7 years of experience in acute healthcare settings including Case Management, Quality Management, or Coding, with at least 3 years in Utilization Management.
- 2 years of management experience in a supervisory or charge nurse role.
- Above average verbal communication skills with heavy public contact and exceptional writing skills.
Nice-to-haves
- Bilingual skills preferred.
- Proficiency in MS Word, MS Excel, and MS PowerPoint.
Benefits
- Flexible work schedule
- Telecommuting options
- Paid holidays
- Opportunities for professional development
