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Health Care Administrators Association® (HCAA) seeks an On-site Utilization Management Nurse Team Lead to supervise RN units and coordinate patient care across stages, ensuring quality, advocacy, and efficient hospital throughput.
You will lead real-time clinical decision-making via bedside huddles and physician consultations, perform on-site medical necessity reviews, issue required notices, and work to minimize avoidable days while protecting reimbursement accuracy.
The On-site Utilization Management (UM) Nurse Team Lead supervises staff RN RUs, ensuring effective coordination across patient care stages. Responsibilities include overseeing patient advocacy, quality monitoring, and collaborating with interdisciplinary teams to optimize hospital throughput, length of stay, and reimbursement accuracy.
Manage staffing, monitor productivity, coach staff, and lead quality and process improvements. Facilitate real-time clinical decision-making through bedside huddles, physician consultations, and ER throughput assessments. Conduct on-site medical necessity reviews using established criteria, issue legally required notices, and minimize avoidable hospital days to reduce financial loss.
Requires an RN license (single or multi-state), BLS certification, and a minimum of 3 years clinical practice plus 1 year in UM or care coordination. Knowledge of case management processes, screening criteria, and strong organizational and communication skills are essential. Preferred CCM certification within 90 days.
Develop staff through orientation and mentorship, participate in performance improvement initiatives, ensure documentation accuracy, and support compliance with healthcare regulations. The role emphasizes leadership, conflict resolution, and fostering a culture of service excellence.