Registered Nurse (RN) - Utilization Management

Matrix Providers • Fairfield, CA

7d • Onsite

About The Position

Matrix Providers is hiring a Registered Nurse (RN) Utilization Management to join our team of talented professionals who provide health care services to our Military Service Members and their families in Fairfield, CA. This is an hourly position, paid bi-weekly. The Registered Nurse (RN) must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/caregivers, medical and nonmedical staff in a professional and courteous way. Must have the knowledge and skills to effectively apply the core case management functions: assessment, planning, facilitation, and advocacy. Must be knowledgeable in medical privacy and confidentiality (HIPAA); accreditation standards of AAAHC and TJC; and computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity is required. The role involves identifying patients for case management, collecting patient information, evaluating care plans, conducting peer reviews, implementing CM services for chronic conditions, collaborating with beneficiaries, educating individuals, providing warm handoffs, serving as a patient advocate, and participating in committees. The RN will also complete assessments of patient, family, and caregiver readiness, coordinate chronic condition care, and perform with minimal supervisory direction. They will independently identify, plan, and carry out projects related to Utilization Management and Medical Management Departments.

Requirements

• Associate's Degree in Nursing.
• Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), National League for Nursing Accrediting Commission (NLNAC), the Commission on Collegiate Nursing Education (CCNE)
• Possess one of the following certifications: American Nurses Credentialing Center (ANCC), Nurse Case Manager (RN-NCM), National Academy of Certified Care Managers: Care Manager Certified (CMC) OR Commission for Case Manager Certification (CCMC): Certified Case Manager (CCM) or American Nurses Credentialing Center (ANCC) -OR- have practiced the equivalent of 2 years full-time as a registered nurse, and have a minimum of 2,000 hours of clinical practice in nursing case management within the last 3 years, and have completed 30 hours of continuing education in nursing case management within the last 3 years.
• Twelve (12) months of recent full-time experience in nursing/health care management for adults, children, families, seniors, or groups is required.
• Possess a thorough clinical knowledge and breadth of experience to be able to contribute to population level assessment and management, identify appropriate Case Management candidates, conduct patient self-care education, and track patient outcomes.
• Extensive knowledge of CM components: outcomes measurement, collaborative practice, patient self-management, population identification processes, and process improvement.
• Current, full, active, and unrestricted license to practice as a Registered Nurse.
• Basic Life Support certification.
• Knowledgeable in medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]).
• Knowledgeable in accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC).
• Proficient in computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity.

Responsibilities

• Identification of patients for case management; comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care.
• Conduct CM staff peer reviews, using approved peer review form, as assigned.
• Proactively implement CM services for populations with chronic conditions, collaborate with beneficiaries in formulating patient-centered goals, and educate individuals, their families or caregivers.
• Provide a warm handoff (person-to-person verbal communication providing continuity of care and a seamless transfer of information) of patients in transition to other levels or places of care by providing pertinent information to the receiving health care provider document warm handoff communications.
• Serves as patient advocate and liaison to healthcare and community agencies for matters concerning primary, secondary, and tertiary healthcare services.
• Actively participates as team member or facilitator of committee or working group.
• Attend multidisciplinary rounds, ward meetings/discharge planning meetings as required to ensure multidisciplinary collaboration and optimal effective communication.
• When possible ensure the patients families and care givers are involved in the case management process.
• Act as a point of contact when there are complex arrangements to be organized for patients.
• Completes and appropriately documents an assessment of patient, family and caregiver readiness, identifies individual health care needs, and proactively coordinates chronic condition care follow-on care.
• Be able to perform with minimal supervisory direction.
• Be able to independently identify, plan, and carry out projects with consideration for the goals and objectives of the MTF’s Utilization Management and Medical Management Departments.
• Proactively identifies and evaluates patients and families for case management from a variety of sources such as discharge/disposition planning, referrals, the Medical Evaluation Board (MEB) process, the healthcare system, employers and facility staff.
• Conducts systematic, on-going, thorough collection of patient’s physical, emotional, psychological, social and medical status and information via direct patient contact and other relevant sources such as professional and non-professional caregivers, medical records, family/caregiver interviews.
• Develops an appropriate patient-specific plan of care to include short and long term goals, objectives and actions.
• Coordinates, collaborates, and obtains approval of the plan among the patient, family/caregiver, primary provider and other members of the healthcare team.
• Guides the patient and family/care giver through the healthcare system, maximizing use of resources.
• Coordinates and executes the plan of care, optimizing access to appropriate services.
• Ensures necessary referrals are ordered by the appropriate discipline and coordinated.
• Serves as an advocate for, and ensures education is provided to, the patient and family/caregiver as required.
• Promotes adherence to treatment plans for improved healthcare outcomes.

Benefits

• Competitive financial package
• Comprehensive insurance package including health, dental, vision, and life coverage.
• Accrued Paid Time Off (PTO)
• Paid Holidays
• 401(k) Plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree