RN Case Management Manager

Utilization Review Coordinator

Assists the Director in coordinating the activities of the Utilization Review Committee inclusive of reports of patterns and trends in resource consumption by patient population and individual physician. Formulation of care management practices to comply with the intent of regulatory and third party payer standards. Identification of delays in care and service by causative factors. Assists in the promotion of professional growth and development of the staff. Assists the Director in the financial management functions of the department inclusive of budget development, implementation and control. Builds consensus to prevent individuals in improvement groups from taking sides and not achieving a workable solution to problems. Collaborates with members of the Clinical Quality Department and utilizes this partnership to expand knowledge base and consistently improve overall reporting process. Collaborates with the Director and Staff to develop, implement, evaluate and continuously improve the Medical Center's Case Management Program, which promotes safe, evidence-based, value-focused care and services with appropriate clinical resource management. Conducts process improvement by tracking interventions and outcomes. Creates an environment where communication is valued by follow-up, using ideas and the unique contributions of others. Creates a nursing care environment that stimulates continuous self-learning, reflective practice, feeling of ownership and demonstration of responsibility and accountability. Develops PowerPoint presentations, Word documents, and reports as needed. Educates physicians and appropriate hospital personnel regarding criteria for Utilization Management. Ensures compliance with all state, federal, and Joint Commission referral / intake regulatory requirements. Ensures optimal customer service / patient experience by role modeling excellent customer service. Fosters development of skills in others through coaching, feedback and encouragement. Guides clinical practice and development of quality improvement initiatives at a unit specialty or system level. Identifies inappropriate bed utilization and quality of care problems and refers them to UR Committee. Leads / facilitates / participates in performance improvement teams and / or activities using current methods and tools. Promotes a patient-focused approach in analyzing and changing processes of care and service. Provides educational assistance to departmental staff, physicians and other members of the interdisciplinary team, about evidence-based practices, clinical outcomes, regulatory and third party payer compliance, and patient transition to alternate levels of care. Supervises the human resource management functions of the department inclusive of interviewing, hiring, orienting, payroll management, staffing, scheduling, performance evaluations, coaching and disciplinary action (when indicated).

Supports Torrance Memorial Medical Center's Values of Service, Excellence, Knowledge, Stability and Community and behaves in a manner that reflects these values. Adheres to the Medical Center's Standards of Behavior. Performs other work as required or requested. Follows privacy and confidentiality rules in accordance with Torrance Memorial Medical Center, State, Federal and HIPAA regulations. Adheres to all Medical Center policies, procedures and guidelines. Attends and participates in staff meetings, performance improvement, workshops / seminars to enhance skills and performance effectiveness. Maintains a neat, clean, and orderly work area. Completes Self Evaluation for annual performance evaluation.

Interacts with all staff, peer, leadership, vendors and providers in the community.

Education

Master's Degree in Nursing

Experience

A minimum of 2 years in a leadership role, 5 years of acute hospital care management experience

License / Certification Requirements

Registered Nurse License

CCM, ACM, CMAC or ANCC Certification within one year of hire

Compensation Range $124,000 - $210,000 / Annually