Registered Nurse Coordinator - Utilization Management

Description

The RN Utilization Management Nurse Coordinator is responsible for both concurrent and retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM department is responsible for LOS and Level of Care to provide effective and efficient health care services that best serve the needs of the patient.

Position Purpose

Nurses in this position work within and contribute to an environment where patient focused outcomes are achieved, and high-quality professional practice is realized. Willing to consider a Hybrid remote work option.

What You Will Do

• Develops, coordinates, and implements staffing plans to ensure adequate care coverage and adjusts department productivity to meet targets.
• Participates in all aspects of utilization management.
• Aid in strategies, plans, and workflow development in the UMCC department.
• Gather and renew denial metrics, review and evaluate LOS O/E metrics for trends and opportunities, manage EPIC work QS to completion, assist with UM scheduling and assignments, mentor/supervise UM staff, assist with education of UM staff regarding new processes and updates, serve on UM committees, assist with UM meetings in gathering and evaluating pertinent data for presentation.
• Manage urgent/emergent situations by reallocating personnel and resources as needed.
• Participate in hiring, evaluating, initiating corrective action and terminating employees as necessary and educate team members in clinical competencies.

Minimum Qualifications

• Graduation from an accredited school of nursing and current licensure in the State of New York.
• Baccalaureate Degree in the Science of Nursing (BSN) from an accredited school of nursing preferred, according to NYS requirements.
• Ten years progressive experience in acute/critical care and/or utilization management may be substituted for a bachelor’s degree.
• Two years’ experience in acute care setting desirable.
• Discharge planning and Community Resource knowledge preferred.
• Specialty credentialing & working knowledge of recognized industry clinical standards i.e., InterQual, MCG Guidelines to clinical nursing practice specialty area preferred.
• Participates in continuing education and updates and maintains knowledge and skills related to specific areas of expertise.

Position Highlights And Benefits

• Comprehensive benefit packages available through Trinity Health.
• Daily pay optin and educational incentives.
• Professional Development: Strong education program, generous tuition allowance and clinical ladder incentives.
• We encourage job share opportunities to enhance satisfaction and growth.
• We encourage participation and support community programs and outreach.

Work/Life

• Scheduling options to balance work/life/school and recreational calendars.

Ministry/Facility Information

• Located in the heart of central New York, St. Joseph’s is one of America’s 50 Best Hospitals for Cardiac Surgery and one of America’s 100 Best for Spine Surgery and Coronary Intervention according to Healthgrades.
• Ranked by Consumer Reports among the top 15 heart surgery centers in the country, a designated Stroke Center, a U.S. News “Best Regional Hospital” and “Best Maternity Hospital”.
• With a comprehensive range of primary-care practices, mental health services, women's and infants' care, and oncology services, St. Joesph’s Health network offers a wide range of innovative, community-based health and wellness programs.
• Our high-quality specialty and mental health services aim to coordinate the continuum of care, as a compassionate healing presence to improve all aspects of health.

Our Commitment

• Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings.
• By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.