Job type full-time
Full job description
Utilization management rn adventhealth tampa
Location address: remote
Full time / days
You will be responsible for:
Supervises daily operations as directed by divisional utilization management manager, including:
Daily supervision of utilization management staff
Primary point of contact for utilization management barriers or concerns
May manage own assignment and department outcomes, as directed
Assists utilization management manager to successfully implement practice changes
Serves as an initial point of contact for all identified stakeholders [i.eUtilization management staff, physician advisor(s), payors, leadership]
Serves as a utilization management content expert regarding medical necessity criteria, patient status, level of care, regulatory compliance, etc.
Performs chart reviews to validate that policy, procedure and standards are met
Escalates operational and/or financial concerns to the physician advisor(s), as appropriate
Reports pertinent quality/risk issues to appropriate individuals, departments and/or committees in a timely manner
Discusses staff, physician, and other department complaints with utilization management manager and follows up with a written report submitted within 24 hours, as needed
Maintains caseload and performs daily pre-admission, admission, and concurrent utilization reviews by leveraging cortex logic to determine appropriate levels of care and support care management team for readiness for discharge, as directed
Knowledge and skills required:
Knowledge of care management processes/workflows
Knowledge of utilization management processes, medical necessity criteria, and compliance guidelines
Ability to lead others effectively
Ability to manage multiple tasks and prioritize level of importance
Critical thinking skills
Customer service skills
Ability to implement process improvement processes
Experience with microsoft applications and development of reports
Strong professional verbal and electronic communication
Ability to negotiate optimal resolution of issues
Knowledge and skills preferred:
Ability to engage in complex clinical decision making
Conflict resolution skills
Ability to analyze, evaluate, and monitor data
Ability to foster positive interdisciplinary team relations and encourage employee engagement
Ability to work independently and/or as part of a team
Education and experience required:
Associate degree in nursing
Minimum three years acute care clinical nursing experience required.
2-3 years of experience in direct utilization management with increasing level of responsibility
Excellent interpersonal communication and negotiation skill.
Strong analytical, data management, and computer skills.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
Education and experience preferred:
Bachelor of science in nursing
Clinical experience in acute care facility
Experience mentoring others
Licensure, certification or registration required:
Licensure, certification or registration preferred:
The utilization management rn supervisor reports directly to the divisional utilization management rn manager and assists in monitoring and performing the daily operations and supervision of team members in the utilization management departmentUtilization management team members will have defined reporting accountabilities directly to supervisors.
The utilization management rn supervisor is responsible for the daily administrative tasks as assigned by the utilization management rn managerThe supervisor will serve as the primary point of contact for utilization management staff, physicians, and payors to provide mitigation for any barriers/concerns that may ariseThe utilization management rn supervisor will be responsible for supporting positive and safe patient outcomes, employee evaluations, and customer experience.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.