Utilization Coordinator, Part-time

Yale New Haven Health•Bridgeport, CT

21h

About The Position

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. At Bridgeport Hospital, we are committed to providing quality medical care and treatment that is coordinated and centered on the patient's specific needs. We strive to achieve benchmarks as a Patient Centered Medical Home and provide health care in a setting where patients are at the center of their care team. All employees of Bridgeport Hospital are part of the patients care team and contribute to the team approach of promoting access, continuous, comprehensive care and work to provide quality improvement in the care provided to their patients. SUMMARY In collaboration with physician(s), actively participates in the quality review process and assures continual improvement of nursing practice and quality patient care. Essential duties and responsibilities include the following . Other duties may be assigned. EEO/AA/Disability/Veteran. RESPONSIBILITIES Provides indirect care to select patients and families. Demonstrates knowledge of developmental stages and applies development theories/concepts when planning and implementing care for the adult patient as observed by supervisor and as indicated by feedback from staff. In conjunction with Care Coordinator monitors patient records to assess the effective utilization of hospital resources. Conducts admission reviews utilizing hospital approved criteria within 24 hours of admission to determine length of stay and compliance with third party payer regulations as evidenced by lack of denials. Acts as an advisor to physicians concerning documentation requirements of third party payers and contractual obligations. Reviews patients records to identify areas of under or over utilization or delays in the scheduling of hospital services. Monitors lab tests, consultations, and diagnostic tests daily to prevent duplication of services and insure completion in a timely manner as observed by supervisor and feedback from staff . Facilitates patients progress through hospital system by monitoring effective utilization of hospital services as evidenced by random review of lengths of stay. Provides appropriate information to third party payers in accordance with departmental policy and procedures as evidenced by third party coverage of hospital staff . Obtains authorization from insurance companies for Extended Care Facilities and relays information to Care Coordinator and/or Social Worker. Participates in data collection aspects of quality review. Assists staff in the collection of quality review data.

Requirements

BSN degree as of January 2020
3-5 years clinical experience in the area of specialty.
Strong interpersonal and leadership skills.
Effective 01/01/2016, an essential function of this position is the requirement to work mandatory rotating Holidays and Weekends in addition to working regularly scheduled hours .
In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences), accountability (being responsible and taking action), and compassion (being empathetic).
Current RN licensure in the State of Connecticut.

Responsibilities

Provides indirect care to select patients and families.
Demonstrates knowledge of developmental stages and applies development theories/concepts when planning and implementing care for the adult patient as observed by supervisor and as indicated by feedback from staff.
In conjunction with Care Coordinator monitors patient records to assess the effective utilization of hospital resources.
Conducts admission reviews utilizing hospital approved criteria within 24 hours of admission to determine length of stay and compliance with third party payer regulations as evidenced by lack of denials.
Acts as an advisor to physicians concerning documentation requirements of third party payers and contractual obligations.
Reviews patients records to identify areas of under or over utilization or delays in the scheduling of hospital services.
Monitors lab tests, consultations, and diagnostic tests daily to prevent duplication of services and insure completion in a timely manner as observed by supervisor and feedback from staff .
Facilitates patients progress through hospital system by monitoring effective utilization of hospital services as evidenced by random review of lengths of stay.
Provides appropriate information to third party payers in accordance with departmental policy and procedures as evidenced by third party coverage of hospital staff .
Obtains authorization from insurance companies for Extended Care Facilities and relays information to Care Coordinator and/or Social Worker.
Participates in data collection aspects of quality review.
Assists staff in the collection of quality review data.
Provides input into the design and the implementation of monitoring and evaluation strategies and tools as indicated by feedback from the Quality Management Department.
Works closely with assigned Care Coordinator, Clinical Reimbursement Coordinator, and Medical Director of Care Coordination, and alerts them of all EHR issues, including observation, denials, Code 44's, etc.
Utilizes relevant research findings to support and advance nursing practice and improve patient outcomes.
Integrates relevant research findings into practice as evidenced by observation and feedback.
Develops nursing guidelines, policies, and procedures based on pertinent research findings as evidenced by documentation.
Assists health care team members in the development of research proposals as evidenced by feedback.
Assists staff in the collection of research data as appropriate as evidenced by feedback from staff.
Reviews pertinent research findings with health care team members as evidenced by observation and feedback from staff.
Collaborates with Care Coordinator, Clinical Reimbursement Coordinator, and Medical Director of Care Coordination, in evaluating new procedures and nursing care practices with staff as evidenced by feedback.
Attends educational seminars to maintain and meet expectations set forth by hospital and departmental standards.
Attends and participates in in-service meetings and other designated training events that will enhance skills on a regular basis as documented by attendance at training seminars.
Maintains knowledge of trends and developments in the field of discharge planning and utilization.