Manager Utilization Management Jobs in Wisconsin

Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by independently assessing needs, developing, and implementing plans of care for transitions across care settings. Inpatient Care Manager also serve as expert consultants and educators for physicians and other health care team members for discharge and transitional care, coordination of internal and community resources, and support the evaluation and improvement of systems of care to support the optimal utilization of health care resources, while maintaining quality of patient care. The Inpatient Care Manager assumes primary accountability for anticipating, assessing, developing, implementing, documenting, advising, and communicating a safe transition plan of care for patients with complex care needs.

• Coordinates post-discharge patient care needs to assure the timely and effective discharge of routine and complex patients from the hospital setting.
• Independently and proactively completes and documents patient assessments which are thorough, timely, age appropriate, and reflect psychosocial support systems, care needs, health plan benefits, level of care determinations for hospitalized patients.
• Coordinates and communicates with patients, families, and the health care team to develop mutually agreeable plans of care that optimize the use of resources to support the particular needs of individual patients.
• Facilitates resolution of issues which present barriers to safe transfers through the use of patient/team care conferences to assure the efficient transition to a lower level of care and to assure the patient/family receives the right care at the right time so that quality and utilization of resources are simultaneously enhanced.
• Ensures systematic and ongoing contact with interdisciplinary staff and continuing care services to assure the safe transition of patients across care settings.
• In collaboration with the interdisciplinary health care team, ensures regulatory and compliance standards are met.
• Perform duties as requested.

• Minimum of two years combined RN experience in the following areas:
• Med/Surg (hospital acute care)
• ICU (hospital acute care)
• Emergency Department
• Home Health
• Skilled Nursing Facilities
• Hospice
• Long Term Acute Care
• Inpatient Rehab
• Utilization Management

• Successful completion of an RN program by date of hire.
• High School Diploma or General Education Development (GED) required.

• This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.

• Registered Nurse License (Washington) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire

• Registered Nurse License (Oregon) within 6 months of hire

• Basic Life Support within 3 months of hire

• Demonstrated ability to interrelate with physicians, nurses, support staff, and patients in interdisciplinary approach.
• Demonstrated ability to work as part of a team and work as a constant patient advocate.
• Basic physical, psychosocial, functional assessment skills.
• Familiar with care process related to discharge and transitional facilities and services.
• Thorough knowledge of principles of teaching and delegation, assessment skills and care planning, and appropriate
• utilization of acute hospital, long-term care, and home care resources.
• Able to develop concise and thorough documentation of patient clinical assessment and care needs.
• Highly effective problem solving, written and verbal communication, customer service, organizational and time
• management skills.
• Ability to effectively provide culturally competent care.
• Ability to navigate conflict in high pressure situations.
• Ability to use fixed and mobile technological devices.

• Knowledge of appropriate utilization of acute hospital and Kaiser Permanente internal resources.
• Knowledge of Medicare and Medicaid regulations related to eligibility requirements: hospital, nursing facilities, home
• health, hospice, and Durable Medical Equipment (DME).
• Knowledge of utilization management principles and tools.
• Demonstrated clinical judgment and customer-focused service skills.
• Knowledge of principles of patient teaching, disease prevention measures, and physical assessment as it relates to the
• needs of patient and the next level of care.
• Certified in Case Management.
• BSN or bachelors degree and MSN.