Utilization Management RN

Summary

GENERAL SUMMARY :

Conducts day-to-day activities for the clinical, financial and utilization coordination of the patients hospital experience. Proactively consults with the interdisciplinary team which includes, but is not limited to, hospital patient care staff, physicians, patient support and family to ensure the patients hospital stay meets medical necessity and insurance authorizations are obtained in order to facilitate the patients and hospitals financial well-being.

PRINCIPAL JOB FUNCTIONS :

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• Commits to the mission, vision, beliefs and consistently demonstrates our core values.

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8. Ensures appropriate resource utilization relevant to the financial, regulatory and clinical aspects of care; proposes alternative treatment to ensure a cost effective and efficient plan of care.

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11. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

12. Participates in meetings, committees and department projects as assigned.

13. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES :

1. Maintains clinical competency as required for the unit including but not limited to age-specific competencies relative to patients growth and developmental needs, annual skill competency verification and mandatory education and competencies.

2. Knowledge of governmental and third party payer regulations and requirements related to patient hospitalization and acute rehabilitation admission, stay and discharge activities, i.e., CMS, CARF, FIM (TM).

3. Knowledge of computer hardware equipment and software applications relevant to work functions.

4. Skill in conflict diffusion and resolution.

5. Ability to communicate effectively both verbally and in writing.

6. Ability to perform crucial conversations with desired outcomes.

7. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

8. Ability to problem solve and engage independent critical thinking skills.

9. Ability to maintain confidentiality relevant to sensitive information.

10. Ability to prioritize work demands and work with minimal supervision.

11. Ability to perform crucial conversations with desired outcomes.

12. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE :

Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act. Minimum of two (2) years recent clinical experience required. Prior care coordination and / or utilization management experience preferred.

OTHER CREDENTIALS / CERTIFICATIONS :

Basic Life Support (CPR) certification required. Bryan Health recognizes American Heart Association (for healthcare professionals), American Red Cross (for healthcare professionals) and the Military Training Network.

PHYSICAL REQUIREMENTS :

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and / or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.