Utilization Mgmt Supervisor - FT - RMC (Washington)

Utilization Management Supervisor

JOB CODE : 15204

FLSA Exemption Status : Exempt

Summary (Basic Purpose Of The Job)

Performs a variety of utilization management activities to promote quality, clinical and cost effective outcomes. Supervises activities of assigned staff in providing utilization review services. Plans, assigns, reviews, and evaluates work of assigned staff to achieve quality output, to operate in a fiscally responsible manner and to achieve operational efficiency and to adhere to established policies, practices, and procedures. Identifies opportunities and takes a leadership role in departmental performance improvement activities. Performs as an effective leader.

Minimum Requirements

Education : Graduation from an accredited school of nursing.

Experience : Five years of job related experience. Previous experience in clinical nursing. Experience in case management field including utilization review and / or discharge planning, outcomes management, assessment, care planning, and care coordination.

Other Credentials : AHA BLS - Healthcare Provider, Registered Nurse - NJ

Knowledge and Skills : Good problem solving and reasoning ability skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Special Training : Intermediate computer skills.

Mental, Behavioral and Emotional Abilities : Ability to interpret a variety of instructions furnished in written, oral, graph, diagram or other format. Ability to manage multiple conflicting priorities effectively and efficiently.

Usual Work Day : Exempt Hours

Reporting Relationships

Does this position formally supervise employees? Yes

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

Essential Functions

• Supervises activities of assigned staff in providing case utilization review.
• Acts as liaison with staff and / or management to handle any problems that arise, identifies alternatives and recommends solutions.
• Ensures equitable distribution of work assignment on a daily basis, adjusts work assignments throughout shift as needed and accepts staff call-outs and arranges alternate staffing as appropriate.
• Evaluates staff to enhance their performance, development, and work product. Addresses performance issues ongoing and through annual performance evaluations, and makes recommendations for personnel actions. Motivates and rewards employees according to company guidelines.
• Participates in interviewing and hiring process of new employees.
• Ensures quality and performance goals of individual UR RN and department - conducts regular, scheduled reviews of utilization managers work product including reviews, payer correspondence, and other contacts and documentation. Conducts routine chart reviews for interrater reliability to maintain accuracy of reviews and maintain documentation requirements, provides ongoing feedback to utilization managers and department management regarding individual and department performance.
• Provides orientation and training of all new Utilization Managers, provides ongoing training and education to all staff members regarding new, evolving and / or changing workflows, timeframes and regulations. Develops training tools as necessary.
• Serves as primary liaison for department with physician advisor program, includes problem solving, orientation of new physician advisors, UR RN referral monitoring for accuracy and effectiveness.
• Serves as primary point of contact for providers within CH for utilization management and level of care questions or issues. Rounds in outpatient areas of responsibility several times a day to ensure timely and accurate exchange of information and reviews.
• Provides on call support to the 24 / 7 UR RN staff (telecommuters) who provide UR support to ALL campuses and each ED room. Includes any input needed for the transfer center, observation units and ALL EDs.
• Provides quarterly education to the medical staff (ED, Residents, Hospitalists) regarding documentation and level of care placement as per MCG guidelines.
• Creates, manages and maintains the 24 / 7 UR RN schedule and assures coverage is always available for all four ED sites. Creates, manages and maintains the Capitalink UR RN on call schedule, providing access for the ED MD to the on call UR RN.
• Provides Coverage for all staffing shortages, including nights and weekends.
• Serves as a member of the retrospective PSO adjustment team. Serves as primary liaison for the department with the finance department regarding billing discrepancies. Manages the daily PSO cerner orders / bed day maintenance by assisting finance, logistics and patient access to assure payment issues are resolved effectively and efficiently.

Physical Demands And Work Environment

Frequent physical demands include : Sitting, Standing. Occasional physical demands include : Walking, Climbing (e.g., stairs or ladders), Carry objects, Push / Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat / kneel / crawl, Wrist position deviation, Pinching / fine motor activities. Continuous physical demands include : Keyboard use / repetitive motion, Talk or Hear. Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include : Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing.

Anticipated Occupational Exposure Risks Include the following : N / A

IND123

Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft.