Utilization Manager Jobs in Cadillac, MI (NOW HIRING)

_ A Day in the Life_

• The Patient Care Manager facilitates progression-of-care; and monitors the patient's progress to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective.

• Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers , and supports RBC unit action plans.

• Uses effective customer service/interpersonal skills at all times.

• Maintains working knowledge/experience in utilization management, managed care, and payer issues that may impact the course of care.

• Timely response to screening referrals for case management services.

• Ability to identify appropriate community resources on assigned caseload and to work collaboratively with patients, families, and multidisciplinary team and community agencies to achieve desired patient outcomes.

• Confirm admission diagnosis and identify related quality/care metrics to promote medical compliance.

• Advocate for patient by assessing that patients healthcare needs are being addressed in the most appropriate level of care.

• Encourages and facilitates patient/family participation in all care and treatment decisions.

• Educates members of the patient's healthcare team on the appropriate access to, and use of various levels of care.

• Identifies patients at risk for readmission and refers them for community based follow up. Recognizes and responds appropriately to readmission or psychosocial risk factors.

• Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.

• Serves as primary liaison between and among physicians, patients, families, payers, external case managers and interdisciplinary clinical team.

• Participates in discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers. Refers appropriate cases to the Complex Discharge planner.

• Collaborates with Post-Acute Coordinators to monitor and facilitate the progress of completing complex post-acute services.

• Interface with utilization review specialists to stay current on patient's eligibility for admission, continuing stay or readiness for discharge according to medical necessity guidelines. (InterQual criteria)

• Persevere in attempts to influence clinical and financial outcomes of care. Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes.

• Participates in quality improvement plan activities and any other departmental research or studies as requested by the department manager.

• Assertively manage resource utilization while appropriately navigating the patient's movement along the continuum of care.

• Collaborate with social workers, counselors and Resource Center coordinators to research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.

• Utilizes the Program Manager, Director and Medical Advisor as expert advisors to gain insights in dealing with physicians and Resource Management issues.

• Works with resource center and providers to determine patient's eligibility for post-acute services.

• May assist in training and orientation of new department employees and students. Performs other duties and responsibilities as assigned.

Qualifications:
Qualifications

_ What’s Required_

• Bachelor's Degree in Nursing or Social Work. Comparable experience will be considered in lieu of a Bachelor's degree in nursing (must have RN license or social work license).

• Must have recent hospital patient care experience (minimum 3 years) and knowledge of hospital operations.

• Must have MSW (LMSW will be considered as well)

Additional Information

This position requires at minimum a Limited Master Social Work license in the state of Michigan

_ Are you Munson Material? Apply today!_

Munson Healthcare requires all employees be vaccinated or have lab confirmed immunity for Measles, Mumps, Rubella and Varicella. MHC also requires all employees to receive a flu vaccine during the flu season in the year that they are hired and annually thereafter, or receive an approved medical or religious exemption.