Utilization Manager Jobs in Rhode Island (NOW HIRING)

SUMMARY:
Reports to the Director of Case Management or designee. Provides coordinated care support to facilitate and expedite discharges of observation patients. Participates in daily observation rounds and collaborates with the clinical healthcare team across the patient care continuum. As a member of that team, shares responsibility for the implementation of the discharge plan; ensures efficient and effective delivery of patient care services through the appropriate utilization of healthcare resources
Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect and Excellence, as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences
Patient and Community Focus and Collaborate
In addition, our leaders will demonstrate an aptitude for:
Ensure Accountability and Build Effective Teams
Drive Vision and Purpose and Optimize Work Processes
By applying core and leadership competencies, leaders help Brown University Health achieve its strategic goals.

RESPONSIBILITIES:

Partners with medical staff, case manager, utilization manager, and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for patients who are admitted observation.

Proactively identifies high-risk patients within this patient population and assists case management to facilitate timely discharge plans.

Collaborates with utilization management to ensure communication between case management and utilization management teams.

Participates in daily observation rounds to collaborate with members of the patient’s healthcare team as well as to evaluate and facilitate development and implementation of the discharge planning process.

Provides clinical supervision and work direction to Case Management staff as needed.

Participates in system-wide 24/7 coverage for clinical and/or scheduling issues.

Ensures team is informed of insurance qualifiers that may affect the discharge plan. Discuss approaching discharge readiness of patients.

Identify and assess readmitted patients and complex patients in collaboration with members of the healthcare team to coordinate discharge.

Advocates for the patient and advises the patient regarding financial implications of their discharge plan when coordinating care for the patient. Communicates the discharge plan, including post facility agency acceptance, to patients, families and all members of the care team.

Provides care plan direction for the advancement of a patient care delivery system which supports managed care strategies and decreases readmission risk. Demonstrates knowledge of federal and state rules and regulations.

Reviews and acts as a change agent by identifying opportunities to improve patient flow and identifies and reduces service delays through problem resolution and follow-up.

Identifies and tracks service and discharge patient delays.

Participates in department, affiliate and system level improvement activities as requested: i.e. weekly long LOS reviews, interdisciplinary rounds, readmission reviews, LOS initiatives.

Participates in orientation of new staff as requested.

Participates in ongoing education-related professional activities and affiliations to maintain an advanced level of knowledge of patient care services third party payer and managed care requirements and case management.
MINIMUM QUALIFICATIONS:
Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.

BASIC KNOWLEDGE:

Graduate of a School of Nursing with current license to practice as a Registered Nurse in the State of Rhode Island.

Bachelor’s Degree preferred; years of experience will be considered.

Certification in Case Management by a nationally organization preferred or to be obtained within 1 year of hire.

BLS Certification required.

EXPERIENCE:

Analytical skills necessary to evaluate patients, programs, and procedures. Administrative and supervisory skills necessary to address case management staff functions in the department and/or assigned clinical area.

Demonstrated ability to exercise independent judgment.

Refers specific complex problems to Manager or Director of Case Management or designee, where clarification of departmental policies and procedures may be required.

Interpersonal skills necessary to establish and maintain effective working relationships and to supervise and coordinate care management activities in the clinical area.

Three years of clinical experience with recent experience in case management, community case management, patient navigation, or discharge planning is strongly preferred.

Strong analytical and interpersonal skills are required to provide guidance to and communicate daily with healthcare professionals, patients and families.

Must exhibit a collaborative approach and method of communication to interact successfully on as daily basis with a wide and diverse population of both health care providers insurers patients and their families.

Demonstrates knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes human development stages and cultural patterns in each step of the care process.

Must be proficient in the use of Microsoft Office software including email and Outlook calendar and have basic keyboarding skills.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

General hospital environment with occasional stressful conditions associated with patient care.

Risk of exposure to blood borne pathogens and disease is minimized and controlled by adherence to Hospital Infection Control policy and procedures.

Must be able to make hospital rounds through various patient care areas either by walking or through some other mobile means.

Visual acuity and finger dexterity is needed to review and carry medical records navigate through automated system screens and type on a typical computer terminal keyboard.

Lifting of up to 10 lbs. may be necessary to transport items from one care unit to the next.

Must have reliable transportation.

INDEPENDENT ACTION:

Responds to individual patient-care situations demonstrating knowledge and skills acquired through education certification and work experience.

SUPERVISORY RESPONSIBILITY:

Will supervise case management staff as appropriate.

Pay Range:

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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