Current Registered Nurse licensure within State of Michigan. BSN preferred.
Minimum of three years clinical experience required. One to three years utilization review in a hospital or insurance industry preferred.
Previous utilization review and/or case management experience preferred.
Demonstrates effective verbal and written communication skills with internal and external customers, i.e., insurance companies, case managers, home care agencies, physicians, nursing staff and ancillary personnel.
Demonstrated ability to successfully work as part of a team
Computer skills (Microsoft Office, Outlook, Internet, typing skills) required; able to adapt to required software programs which support Utilization Management functions. Familiarity with health care documentation systems preferred (i.e. Cerner PowerChart, FirstNet)
Demonstrated creative problem-solving skills and a strong attention to detail and accuracy required
Experience and knowledge in discharge planning â preferred
Possess knowledge of managed care insurance, governmental health programs, HMO’s and their impact on hospital and post hospital care reimbursement.
Must be able to work independently, anticipate and organize workflow, prioritize and follow through on responsibilities.
Must possess the strong clinical assessment and critical thinking skills necessary to provide utilization review responsibilities.
Superior organization and time management skills required; able to skillfully manage a high-volume caseload and to respond effectively to rapidly changing priorities
Reports to Manager of Care Management.
Works collaboratively with: Case Management, Risk Management, Medical Staff, Nursing Services, Ancillary Departments, Medical Records, Patient Access Services, and Business Office, as well as other disciplines within Utilization Management.
AGE OF PATIENTS SERVED
Cares for patients in the age category(s) checked below:
X All ages (birth & above) _ Infant (1 mo â 1 yr)
_ Neonatal (birth â 1 mo) _ Young adult (18 yrs â 25 yrs)
_ Adult (26 yrs â 54 yrs) _ Adolescence (13 yrs -17 yrs)
_ Early childhood (1 yr – 5 yrs) _ Sr. Adult (55 yrs – 64 yrs)
_ Late childhood (6 yrs -12 yrs) _ Geriatric (65 yrs & above)
_ No direct clinical contact with patients
Supports the Mission, Vision and Values of Munson Healthcare.
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
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 compliance with state and federally mandated regulations; maintains current knowledge of regulatory changes impacting utilization management and insurance authorization.
Coaches, provides feedback, and guides others in a collaborative and mutually supportive environment; serves as a resource for others with less experience.
Maintains standards of professional practice.
Performs other duties and responsibilities as assigned.
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