• Monitors work performance of the Utilization Management Nursing Staff and provides guidance as necessary.
• Facilitates an effective and efficient workflow process of the UM Staff and ensures completion of all assignments.
• Assists in the orientation of new personnel.
• Provides back-up support for telephone UR to ensure adequate staff coverage.
• Assists staff with problem resolution of UR issues.
• Acts as a liaison and resource person between the Staff Development Nurse, UR Nurse, and Management.
• Assists with the implementation of UR Policies and Procedures.
• Prepares the UM Work Schedule for approval and ensures adherence to the Work Schedule Policy and Procedure.
• Reviews Diary Comments of the UR Nurses for potential process improvement issues.
• Educates the Medical Staff and Nursing Staff on Utilization Management and provides specific information related to case types, including financial data.
• Maintains a mechanism for the review of quality of care issues arising during concurrent review and identifies areas of potential medical liability.
• Monitors and facilitates appropriate utilization of resources.
• Assigns and monitors lengths of stay.
• Tracks and reports trends of inappropriate resource utilization to Director/ Assistant Director of Utilization Review.
• Maintains a documentation system of all review activities and enters appropriate variances using the approved variance codes.
• Maintains clinical expertise in specialty area and/or general nursing.
• Provides assistance regarding clinical issues to non-nursing utilization review staff.
• Contributes to the success of UTMB Managed Care Organization.
• Performs a variety of marginal duties not listed, to be determined and assigned as needed.

Knowledge and Skills:

• Must be self-motivated, willing, and able to learn multiple aspects of the job.
• Able to demonstrate both written and verbal communication skills.
• Demonstrate excellent interpersonal skills and telephone etiquette.
• Demonstrates history of accuracy, tenacity, and attention to detail.

Standard office equipment. 

Working Environment:

• Standard office environment, including exposure to air conditioning, heating, and outside elements to and from work and during meal break times.
• May involve traveling. 
• May involve occasional shift work and weekends as needed to accommodate the operations 24 hours a day, seven days a week. 

Other: 

Specific job requirements or physical location of some positions allocated to this classification, may render this position security sensitive, and thereby subject to the provisions of Section 51.215, Texas Education Code. 

Any qualifications to be considered as equivalents in lieu of stated minimums require the prior approval of the Chief Human Resources Officer.