RN Utilization Review

We need to output HTML fragment with sections: About the role? Actually the posting includes "Job Description Summary About UofL Health:" then "Job Description Position Summary and Purpose". Then "Essential Functions", "Other Functions", "Additional Job Description Job Requirements (Education, Experience, Licensure and Certification)", "Job Competency Knowledge, Skills, and Abilities critical to this role:", "Additional Responsibilities", "UofL Health Core Expectation". Also there is address and shift info at top: "Address 250 East Liberty St. Louisville, KY 40202 Shift Salary Shift (United States of America)". That seems like metadata: address, shift, salary? Actually "Shift Salary Shift" weird. Probably we should fold minor metadata into a short

or drop it. The instruction: "Do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

or drop it." So we can include address and shift info in a

. No salary given. So we can include a paragraph with address and shift. We must not repeat job title as heading. No job title given explicitly; but we can ignore. We need sections only when posting has real specific content. So we need sections: About the role? The posting includes "About UofL Health:" which is about the organization, not role. Could be "About the role" but we have "Job Description Summary About UofL Health:" maybe treat as "About the role"? Actually "About UofL Health" is about the employer. Could be a section "About the organization". But instruction says use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we should map content to those headings where appropriate. We have: - About UofL Health: could be "About the role"? Not exactly. But we could put under "About the role" a description of the role? Actually the role description is in "Position Summary and Purpose". That could be "About the role". So we can put that under

About the role

with paragraphs. - Responsibilities: Essential Functions and Other Functions could be combined under Responsibilities. - Requirements: Education, Experience, Licensure and Certification -> "Job Requirements (Education, Experience, Licensure and Certification)" => Requirements section. - Qualifications: maybe same as Requirements? But we can treat Job Competency Knowledge, Skills, and Abilities as Skills section. - Additional Responsibilities could be part of Responsibilities. - UofL Health Core Expectation could be maybe "About the role" or separate? Could be "About the role" as well. But we already used About the role for position summary. Could add another paragraph. We must not create sections with filler. So we need to ensure each heading has substantive content. Let's extract content: About UofL Health paragraph: "UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day." Position Summary and Purpose: long paragraph describing Utilization Review RN duties. Essential Functions: list of bullet-like sentences each starting with a verb. We need to convert to

• . Other Functions: also list. Job Requirements: Education, Experience, Licensure and Certification: we can list. Job Competency Knowledge, Skills, and Abilities critical to this role: list of bullet-like sentences. Additional Responsibilities: list. UofL Health Core Expectation: list of bullet-like sentences. We also have address and shift info: "Address 250 East Liberty St. Louisville, KY 40202 Shift Salary Shift (United States of America)". Probably we can make a

  with that. We must not include boilerplate like EEO etc. Not present. Now produce HTML fragment. Structure:

  Address: 250 East Liberty St., Louisville, KY 40202. Shift: ...? Actually the text: "Address 250 East Liberty St. Louisville, KY 40202 Shift Salary Shift (United States of America)". Might be garbled. We'll just include as is: "Address 250 East Liberty St. Louisville, KY 40202 Shift Salary Shift (United States of America)". Maybe better to separate: "Address: 250 East Liberty St., Louisville, KY 40202. Shift: ... Salary: ... (United States of America)". But we shouldn't invent. We'll just put the given string. Then sections:

  About the role

  Position Summary and Purpose ...

  UofL Health Core Expectation ...? Actually core expectation maybe separate section? Could be "About the role" includes both? Might be better to have separate section "About the organization"? But instruction limited headings list; we can use "About the role" for role summary and maybe also include core expectation as part of role? Might be okay. Alternatively we could have "About the role" for position summary, and "UofL Health Core Expectation" could be placed under "About the role" as another paragraph. Responsibilities: combine Essential Functions and Other Functions into a single

  • list. Requirements: Education, Experience, Licensure and Certification: we can make a
    • . Skills: Job Competency Knowledge, Skills, and Abilities:
      • . Additional Responsibilities: maybe also under Responsibilities? But we already have Responsibilities covering essential and other functions; additional responsibilities could be added to same list. We must not repeat content. Let's extract each bullet. Essential Functions list (as sentences): - Promotes optimal management of clinical resources by conducting timely admission and concurrent utilization review for all patients of designated medical services; certifies medical necessity for admission, continued stay and discharge reviews for patients certified by utilizing the current MCG criteria; documents clinical information in Case Management Software system - During the concurrent review process, evaluates the medical record to identify any process delay impacting the timeliness of patient care in a collaborative effort to ensure that the appropriate resources are utilized (i.e. physical therapy, cardiac rehabilitation, or nutritional service) - Supports the utilization review program by maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers - Communicates closely with third party payors to ensure all pertinent clinical information is provided to secure an authorization; appropriately documents information regarding the authorization number and the approved length of stay on the Case Manager Software - Advocates for patient/family needs in a respectful, non-judgmental, and confidential manner - Serves as a resource to physicians for clinical management and financial issues; assists the providers with promoting efficiencies in the care delivery system and reducing/ eliminating barriers to efficient/effective service - Reviews patient cases for potential problems with OIG Workplan Audits and compliance issues; reports problems and makes recommendation to appropriate departments - Appropriately refers cases to manager/director of care coordination, CAO, or medical director when intensity of service or severity of illness is not present and is unable to resolved - Educates physicians, patients, and staff with regards to payors, financial issues, documentation, and potential compliance issues - Investigates and responds to billing concerns from Business Office, Health Information Management, Admitting, and other sources; resolves financial and billing problems, such as appropriate patient status, correct payor source, denials, appeals, and system issues Other Functions list: - Develops a cooperative, assistive relationship with third-party reviewers, working to facilitate timely, positive responses for patient accounts - Attends Monthly Departmental Staff Communications Meetings. - Serves as an active member of committees, as needed, which may include a variety of projects or topics - Enhances professional growth and development through participation in educational programs, reading current literature, attending in-service meetings and workshops that are related to assigned areas of responsibility. - Maintains compliance with all company policies, procedures and standards of conduct - Complies with HIPAA privacy and security requirements to always maintain confidentiality - Performs other duties as assigned Additional Responsibilities list: - Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor always - Maintains confidentiality and always protects sensitive data - Adheres to organizational and department specific safety standards and guidelines - Works collaboratively and supports efforts of team members - Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community UofL Health Core Expectation list: - Honoring and caring for the dignity of all persons in mind, body, and spirit - Ensuring the highest quality of care for those we serve - Working together as a team to achieve our goals - Improving continuously by listening, and asking for and responding to feedback - Seeking new and better ways to meet the needs of those we serve - Using our resources wisely - Understanding how each of our roles contributes to the success of UofL Health Now Requirements: Education: ADN or Associate’s degree in nursing (Required); Bachelor of Science in Nursing (preferred); An RN with a bachelor's degree in business, Health Care Administration or equivalent on the condition that they enroll in a BSN program within one year of employment and complete the BSN within three years of employment Experience: Two (2) years’ experience as an RN (required); Additional (1) year experience in case management/utilization management (preferred); Three years’ experience with Behavior Health experience (required for positions at Peace Hospital) Licensure: Active Kentucky Registered Nurse License or compact license with privileges to work in Kentucky Certification: Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) preferred We can make a
        • for each bullet. Skills (Job Competency Knowledge, Skills, and Abilities): - Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff - Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required - Assumes responsibility of person growth and development, maintains competency in care management/utilization management principles - Maintains current and accurate knowledge regarding commercial and government payers and Joint Commission regulations/guidelines/criteria related to utilization review - Knowledgeable of state laws, CMS conditions of participation, and TJC standards regarding regulatory requirements for care management and utilization management - Knowledgeable of the services lines and uses sound nursing judgement and adheres to the code of professional conduct. - Understands and can exhibit RN licensure scope of practice - Must be able to adjust work hours depending upon departmental and organizational needs as determined by the director or manager of care coordination or the CNO - Functions within RN scope of practice and UM policies; adhere to CMS Conditions of Participation and Payer requirements. - Language Ability: Must be able to communicate effectively in both verbal and written formats - Reasoning Ability: Able to critically think through complex patient situations, process improvements, evidence-based practice; Able to assist others in developing clinical reasoning skill; Able to break down problems or tasks; scanning one’s own knowledge and experience to identify causes and consequences of events - Computer Skills: Proficient in Microsoft Word, Excel and Outlook; Basic computer skills including the use of electronic medical records; Must have the capacity to learn other relevant systems and databases, as needed We can keep as list items. Now About the role: we have Position Summary and Purpose paragraph (long). Also we could include the About UofL Health paragraph maybe as "About the organization". But not in headings list. Could add a

          before sections describing employer. That's okay. Thus final HTML:

          Address 250 East Liberty St. Louisville, KY 40202 Shift Salary Shift (United States of America)

          About the role