Ensures cost effective and quality patient care by appropriate utilization of hospital resources. Acts as a resource to the medical staff, administrative staff, and external regulatory agencies in all issues relating to utilization management. Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees. Assures compliance with federal, state, JCAHO, other regulatory agencies and internal standards and requirements. Facilitates educational training for medical staff on issues related to utilization management. Requires a master's degree, current RN license, and at least 7 years of experience. Familiar with a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Performs a variety of tasks. Leads and directs the work of others. A wide degree of creativity and latitude is expected. Typically reports to top management.
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