Utilization Management Jobs in Iowa (NOW HIRING)

UnityPoint-St Luke's

Part-Time WEEKEND PACKAGE

Friday 4pm-8pm, Saturday and Sunday 8am-4:30pm

Coordinates patient care across the acute care continuum by partnering with physicians, nursing, social services, and ancillary teams to develop and implement an interdisciplinary plan of care. Conducts admission and ongoing assessments, monitors clinical progress and resource utilization, and leads safe transitions of care, including discharge planning and referrals to community services. Educates patients and families, addresses psychosocial and social determinants of health barriers, and collaborates with Utilization Management regarding level of care considerations. Serves as the central communicator to promote collaboration, continuity, and achievement of defined outcomes such as reduced readmissions and optimized length of stay.

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At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.  

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few:   

• Expect paid time off, parental leave, 401K matching and an employee recognition program.   

• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.  

• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.   

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.  

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. 

Find a fulfilling career and make a difference with UnityPoint Health.

Care Coordination and Discharge Planning

Screens and assesses patients to identify clinical, psychosocial,
financial and legal concerns that affect recovery and transition
needs
• Prioritizes patients for care coordination using screening tools.
• Develops and coordinates an individualized plan of care
• Supports interdisciplinary care rounds and documents the plan in
the medical record
• Collaborates with patients, families, providers, nursing, social
work, payers, and agencies to eliminate barriers, arrange services,
and execute safe transitions across levels and locations of care
• Coordinates access to post-acute resources including home care,
equipment, medications, therapies and follow-up appointments
• Provides thorough handoff to the next care team
• Monitors progression of care, avoidable days and length of stay
targets
• Escalates issues that may result in failed discharge or readmission
• Maintains thorough and timely documentation of assessments,
plans and interventions to ensure continuity and regulatory
compliance

Regulatory Compliance

Administers and/or delegates administration of Medicare notices
per regulatory guidelines.
• Collaborates with Utilization Management specialists
• Coordinates pre-authorization for diagnostic tests, procedures and
treatments with payers
• Communicates Utilization Management determinations impacting
discharge planning and resource utilization with the care team.
• Functions as a resource for external agencies requiring clinical
review of patient conditions and carE

Patient and Family Education

Assesses patient and family learning needs and readiness
• Formulates and updates individualized teaching plans in
coordination with the care team and evaluates outcomes
• Facilitates education regarding disease process, treatment plan,
medications and self-management; empowers patients and
families to utilize healthcare resources appropriately
• Provides ongoing education throughout hospitalization and
transition, reinforcing discharge instructions and coordinating
community resources to support continuity of care
• Acts as a clinical resource and mentor to staff on care coordination
practices, criteria application and documentation standards

Quality of Care and Performance Improvement

Monitors readmissions, length of stay, avoidable days and other
indicators
• Identifies trends and implements improvement opportunities with
multidisciplinary partners
• Performs quality data collection and reporting as assigned
• Supports development of policies and forms to meet regulatory
and documentation requirements
• Engages in process improvement initiatives to enhance patient
flow, effectiveness of care coordination and transitions of care
• Supports and coaches accurate clinical documentation by
physicians and the healthcare team to optimize outcomes and
compliance

• Education: Graduate of an accredited nursing program (Associate’s Degree in Nursing or nursing diploma) required.  Bachelor of Science in Nursing (BSN) preferred.
• Experience: 3 years Clinical RN experience in acute care or hospital settings, collaborating with multidisciplinary teams and caring for specific patient populations required.  
• License/Certifications:  Valid RN license in the state(s) of practice, including eligibility under a NLC multistate license.  Iowa Board of Nursing (IABON)  required. Dual licensed positions must obtain and submit proof of dual licensure within 90 days of hire/transfer; proof of application is acceptable during this period. IA Child Abuse Mandatory Reporter Training in state(s) where providing care  IA Adult Dependent Abuse Mandatory Reporter Training in state(s) where providing care.
• Knowledge/Skills/Abilities:  Communication and Collaboration: Effective verbal and written communication with patients, families, physicians, and diverse professional, educational, and lifestyle backgrounds. Demonstrates multicultural sensitivity, patient/customer focus, strong interpersonal skills, and the ability to negotiate and establish effective working relationships.  Clinical Proficiency and Nursing Process: Knowledge of the nursing process and
  management of patient care, with the ability to provide age- and diagnosis-appropriate services across the continuum. Understands disease processes and current therapies/drugs.  Critical Thinking and Decision-Making: Demonstrates critical thinking, independent judgment, problem solving, conflict resolution, priority setting, time management, and organization; maintains a professional demeanor and copes effectively in stressful situations.  Utilization Management Expertise: Knowledge of utilization management with ability to incorporate into care management activities.  Discharge Planning and Social Services: Knowledge of discharge planning processes and social services in a healthcare setting, including crisis intervention, support counseling, understanding impacts on activities of daily living, and working knowledge of community
  resources for referrals and equipment.  Regulatory and Reimbursement Knowledge: Working knowledge of Medicare regulations, payer-based reimbursement rules, prospective payment systems, QIO activities, and applicable federal and state laws; understands and applies protocols, policies, and procedures.  Technology Proficiency: Proficient computer skills, including Microsoft Office, email and web usage, and documentation in electronic health records; comfortable with keyboard and application skills and able to learn and work with multiple software/hardware.  Professionalism and Confidentiality: Maintains discretion in handling highly confidential information and demonstrates high integrity and honest, professional behavior with highly diverse populations.  Equipment Use: Competent in the use of usual and customary equipment required to perform essential functions of the position.