Registered Nurse Coordinator - Utilization Management

Trinity Health

6d•$42 - $59•Onsite

About The Position

The RN Utilization Management Nurse Coordinator is responsible for both concurrent and retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM department is responsible for LOS and Level of Care to provide effective and efficient health care services that best serve the needs of the patient. Nurses in this position work within and contribute to an environment where patient focused outcomes are achieved, and high-quality professional practice is realized. Registered Nurse Coordinator is a dynamic leadership role that contributes to the operational management of the unit to promote and support an environment of excellent patient care. An individual in this role ensures compliance with all healthcare standards and requirements established by various licensing, regulatory, and accreditation bodies. A Coordinator maintains a working knowledge of policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. A Coordinator provides department/unit-based leadership while engaging staff and promoting evidenced based practice that supports and leads unit and/or organizational changes. A RN Coordinator helps to identify problems, offers solutions, and participates in their resolution. A candidate for this role should be comfortable providing patient care, managing staff, making decisions independently, and assuming managerial duties as necessary.

Requirements

Graduation from an accredited school of nursing and current licensure in the State of New York.
Baccalaureate Degree in the Science of Nursing (BSN) from an accredited school of nursing preferred, according to NYS requirements.
Ten years progressive experience in acute/critical care and/or utilization management may be substituted for a bachelor’s degree.
Two years’ experience in acute care setting desirable.
Discharge planning and Community Resource knowledge preferred.
Specialty credentialing & working knowledge of recognized industry clinical standards i.e., InterQual, MCG Guidelines. to clinical nursing practice specialty area preferred.
Participates in continuing education and updates and maintains knowledge and skills related to specific areas of expertise.

Responsibilities

Develops, coordinates, and implements staffing plans to ensure adequate care coverage and adjusts department productivity to meet targets.
Participates in all aspects of utilization management.
Assist with strategies, plans and workflow development in the UMCC department, gather and renew denial metrics, review and evaluate LOS O/E metrics for trends and opportunities, manage EPIC work QS to completion, assist with UM scheduling and assignments, mentoring/supervising UM staff, assist with education of UM staff regarding new processes and updates, serve on UM committees, assists with UM meeting in gathering and evaluating pertinent data for presentation.
Manages urgent/emergent situations by reallocating personnel and resources as needed.
Participate in hiring, evaluating, initiating corrective action and terminating employees as necessary and educates team members in clinical competencies.