Provides overall technical direction and administration to case management and utilization review personnel, ensuring services are provided efficiently and effectively. Regularly reviews and revises, as necessary, relevant standards and ensures services performed comply with all hospital, system, and regulatory agency standards. Coordinates provision of services with other nursing and medical functions and serves as technical resource for departmental personnel. As an expert in the assigned area, is a resource person to both staff and physicians. Oversees, guides, and mentors the entire team to ensure patients (a) receive the right level of care at the right time predictably and (b) requiring referral care and/or services receive them in a timely manner. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES + Plans and administers directly, and through subordinate supervisory personnel, the effective management and delivery of case management and utilization review services in accordance with all hospital, system, and regulatory agency standards. + Assists with ensuring quality, financial, and customer service objectives are met. + Assists with developing and administering capital and operating budgets to meet agreed-upon departmental goals and objectives. Implements appropriate methods to monitor adherence to budgets and resolve variances. + Serves as technical resource to subordinates in resolving complex problems and in investigating and recommending corrective actions in response to incident reports and/or patient complaints. + Assists with recommendations for new supplies and minor equipment purchases. + Fosters smoothly running case management and utilization review services and processes through timely and effective resolution of disruptions. + Ensures the attainment of objectives through the selection, development, training, and evaluation of case management and utilization review services staff. + Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. QUALIFICATIONS REQUIRED + Bachelor's degree in a health-related field + State license as a Registered Nurse (RN) + Four years of professional experience in RN patient care and case management and/or utilization review QUALIFICATIONS PREFERRED + Master's degree in business or a health-related field. + Two years of experience in supervision + Previous experience as utilization reviewer/care coordinator with knowledge of third-party reimbursement requirements. + Case management, clinical documentation management, coding certifications. + BLS certification. Certification must be issued directly by the American Heart Association (AHA), American Red Cross (ARC), or Canadian equivalent.