Nurse Manager, Utilization Management

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.

This is a remote 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.