Trinity Health Utilization Manager- contingent / flex in Chelsea, Michigan
*Position Summary: *The RN Utilization Manager’s role is to oversee and coordinate utilization management and collaborate on patient discharge planning activities for assigned caseload. Facilitates appropriate utilization of resources and efficient patient progression through continuum of healthcare, resulting in the highest quality and most cost-effective care.
*Qualifications: *Current licensure as a Registered Nurse, BSN preferred. Registered nurse with broad clinical experience. Detail oriented, able to recognize opportunities to teach and learn, able to develop, evaluate and revise work processes. Demonstrates an understanding of reimbursement and other regulatory issues, as well as clinical or utilization experience.
Essential Functions and Responsibilities:
Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participates in their resolution.
Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Chelsea/Saint Joseph Mercy Health System. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
Maintains knowledge to perform the duties of the job. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
Demonstrates self-directed learning.
Behaves in accordance with the Mission, Vision and Values of St. Joseph Mercy Chelsea/Saint Joseph Mercy Health System.
Provides quality patient care by considering the age specific, development and cultural needs through competent clinical practice. Demonstrates unit/area competencies.
Identifies and assists in resolution of problems related to safety, sanitation and maintenance of the environment.
Practices effective communication in all interactions (patient, visitor, co-worker, etc.)
Promotes a positive work environment by demonstrating teamwork.
Evaluates the appropriateness, medical necessity, level of care and efficiency of health care services and procedures according to established criteria or guidelines under the provisions of an applicable health benefits plan.
Demonstrates a complete understanding of current regulatory and reimbursement requirements.
Conducts pre-certification, readmission and continued stay reviews, peer reviews, audits and clinical case appeals.
Communicates and collaborates with the interdisciplinary team to develop and implement timely discharge plans and address length of stay concerns. Communicates information in a timely manner to third party payers.
Facilitates, problem solves, and expedites patient placement decisions and resource allocation to achieve clinically appropriate and operationally effective outcomes.
Other Functions and Responsibilities
1) Performs other duties as assigned.
Required Education, Experience and Certification/Licensure
1) Current licensure as a registered nurse with broad clinical experience. BSN preferred.
Required Skills and Abilities
1) Detail oriented, able to recognize opportunities to teach and learn, able to develop, evaluate and revise work
2) Demonstrates an understanding of reimbursement and other regulatory issues, as well as clinical or utilization
This document is intended to describe the generalized duties and responsibilities, the specialized job functions, and the essential requirements of this job. It is not intended to be an exhaustive statement of all supplemental duties, responsibilities, or non-essential requirements or reflect any accommodations made under the American’s with Disability Act, the Michigan Handicapper’s Act, or SJMHS’s Return to Work Program
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Number: 00151991
Location: Chelsea, MI
Organization Name: Saint Joseph Mercy Health System
Facility: SJSEMI - SJMHS Chelsea Comm Hospital
Employment Type: Part time