The transition of a large, ten-hospital healthcare system’s internal Utilization Review (UR) program to an outsourced, centralized model involved managing a substantial remote nursing workforce, presenting unique challenges in the virtual setting. Recognizing the significance and scope of the transition, several noteworthy management strategies were actively employed in three key areas: People, Process, and Technology.

Based on industry best practices, this project encompassed the review of hospital admissions to assess initial and ongoing medical necessity. The project was planned and executed in a short-term, condensed, three-month timeline, facing challenging circumstances and leading to issues like high attrition, confusion, errors, staff dissatisfaction, and failure to achieve targeted productivity goals. These challenges posed significant risk for a potential shortfall in achieving the goals and objectives of the project.

• People: A cornerstone of successfully managing a team is knowing your people well. Employing clear, frequent, appropriate communication was complemented by mechanisms and settings allowing staff to escalate concerns. Additionally, timely objective feedback regarding performance established the foundation for the success of the team and its members.
• Process: The hospital system implemented new processes simultaneously with the initiation of the centralization of the UR work. Managing the timeline of the changes, providing frequent pertinent feedback on individual and team performance, and closely monitoring staff hours and outcomes contributed to the incremental successes during the transition to outsourcing and centralizing the UR work.
• Technology: In managing the remote team of nursing professionals, identifying available technologies, understanding and leveraging the functionality of those technologies, and educating staff on how to apply them were crucial to the success of this project.

Recognizing the unique aspects of managing professional nurses virtually by addressing People, Process, and Technology elements, the outsourcing and centralization of the hospital system’s UR program was successful.