Utilization Review Educator

Beacon Health System • Granger, IN

110d

About The Position

Reports to the Manager/Utilization Review and Case Management. Is responsible for assessing, planning, coordinating and evaluating orientation, continuing education and in-service programs for staff which are competency based. Recommends improvements in the quality of utilization review practice and standards. Serves as a resource to staff. Assists with steps to resolve preventable denials and coordinates with the Manager to identify and correct weaknesses in the revenue cycle process that can mitigate future denials.

Requirements

• Bachelor of Science in Nursing degree and current license to practice as a Registered Nurse in Indiana.
• Two years of recent utilization review/case management experience is required.

Nice To Haves

• Master's degree in Nursing or advanced degree is preferred.

Responsibilities

• Develops curriculum and keeps current new hire orientation for all positions affecting UR at both hospitals and any other positions associated with UR Departments.
• Develops schedules, teaching methods, evaluation tools, preceptor development programs, and coordinates for all parties a smooth onboarding and training process.
• Works with manager to assure performance progress is documented and feedback whether positive or corrective for timely movement through orientation phase.
• Assess learning needs of UR associates and develops plan, goals, and validates with management and associates.
• Assures competency assessment of staff working in UR Process through audits, direct observations/discussions, and individual education plans as needed.
• Responsible for all staff development activities around upgrades to UR tools, criteria sets, and other mechanisms/processes needed in UR process.
• Assists as a resource regarding UR situations of concern and decision making.
• Keeps records of all education and competency validation activities.
• Leads or participates in strategic initiatives in the revenue cycle where utilization review plays a role and communicates relevant information to other departments.
• Supports management communications and actions to assure effective change management culture in departments.
• Evaluates work processes, identifies inefficiencies, lack of standardization, and opportunities for improvement.
• Collects information through data collection, observations, surveys, interviews, etc., to analyze the process.
• Develops metrics for success and collaborative approach to design improvement.
• Implements PDCA and LEAN tools as indicated to refine, measure, revise, and sustain improved processes in UR.
• Monitors select measures for oversight committees and prepares timely reports.

What This Job Offers

• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees