Nurse Manager I - Utilization Management (Continuum of Care) Renton WA
Overview
Responsible for overseeing clinical review, transition of care, post-hospital discharge nursing, and high-cost claimant work. Requires leadership of a large team and coordination across the continuum of care to ensure safe, efficient patient care and proper utilization of resources. Must live in Washington State or Idaho.
Essential Responsibilities
Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicit and act on performance feedback; coach to drive performance improvement. Lead, adapt, implement, and stay up to date with organizational change, best practices, processes, and industry trends. Foster open dialogue, motivate collaboration, delegate appropriately, and support staff in decision-making.
Manage designated work unit or team by translating plans into actionable items; ensure policy compliance; align efforts; set standards and measure progress; resolve escalated issues; develop work plans and allocate resources; remove obstacles and address improvement opportunities.
Oversee continuum of care / care-at-home operations to support patient care, including reporting, data review, and translating reports into operational initiatives; manage recruitment and standardized processes for staff; lead survey and compliance readiness activities; assist in department budgeting (expenditures, payroll, and non-payroll) with guidance from leadership.
Ensure standardized care delivery by developing partnerships with physicians and experts; monitor daily operations; manage clinical area resources; support contract/vendor relations; implement emergency preparedness programs and ensure staff training; lead project teams and monitor delivery against objectives.
Lead improvements to operations and technology processes by defining issues, setting goals, identifying root causes, and implementing solutions; ensure performance metrics align with department initiatives.
Minimum Qualifications
Bachelor’s degree in Nursing (BSN) and a minimum of three (3) years of experience in business operations, clinical health care, or a related field.
Minimum two (2) years in a leadership role with or without direct reports.
Minimum two (2) years of customer or member/patient service experience.
Registered Nurse License (Washington) required at hire OR Compact License: RN required at hire.
Basic Life Support required at hire.
Additional Requirements
Knowledge, Skills, and Abilities: Evidence-Based Medicine Principles; Compliance Management; Confidentiality; Member Service; Conflict Resolution; Stakeholder Management; Legal And Regulatory Requirements; Microsoft Office; Health Care Quality Standards; Information Systems.