Utilization Review Supervisor - FT - Day - Utilization Resource Management Pennington NJ

Position Overview

Note - This is not a remote position*

Performs a variety of utilization management activities to promote quality, clinical and cost-effective outcomes.

Supervises activities of assigned staff in providing utilization review services.

Plans, assigns, reviews, and evaluates work of assigned staff to achieve quality output, to operate in a fiscally responsible manner and to achieve operational efficiency and to adhere to established policies, practices, and procedures.

Identifies opportunities and takes a leadership role in departmental performance improvement activities.

Performs as an effective leader.

Minimum Requirements

• Education: Graduation from an accredited school of nursing.
• Experience: Three years job related experience. Five years’ experience in clinical nursing. Experience in case management field including utilization review required and/or discharge planning, outcomes management, assessment, care planning, and care coordination.

Other Credentials

• Registered Nurse - NJ

Knowledge and Skills

• Good problem solving and reasoning ability skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Special Training

• Intermediate computer skills.

Mental, Behavioral and Emotional Abilities

• Ability to interpret a variety of instructions furnished in written, oral, graph, diagram or other format.
• Ability to manage multiple conflicting priorities effectively and efficiently.

Usual Work Day

• 8 Hours

Reporting Relationships

• Does this position formally supervise employees? Yes
• If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

Essential Functions

• Supervises activities of assigned staff in providing case utilization review.
• Acts as liaison with staff and/or management to handle any problems that arise, identifies alternatives and recommends solutions.
• Evaluates staff to enhance their performance, development, and work product.
• Adds performance issues ongoing and through annual performance evaluations, and makes recommendations for personnel actions.
• Motivates and rewards employees according to company guidelines.
• Participates in interviewing and hiring process of new employees.
• Ensures quality and performance goals of individual UR RN and department - conducts regular and scheduled reviews of utilization RNs work product including reviews, payer correspondence, and other contacts and documentation.
• Conducts routine chart reviews for interrater reliability to maintain accuracy of reviews and maintain documentation requirements, provides ongoing feedback to utilization managers and department management regarding individual and department performance.
• Provides orientation and training of all new Utilization RNs, provides ongoing training and education to all staff members regarding new, evolving and/or changing workflows, timeframes and regulations. Develops training tools as necessary.
• Serves as liaison for department with physician advisor program, includes problem solving, orientation of new physician advisors, UR RN referral monitoring for accuracy and effectiveness.
• Serves as primary point of contact for providers within CH for utilization management and level of care questions or issues.
• Rounds in outpatient areas of responsibility several times a day to ensure timely and accurate exchange of information and reviews.
• Provides on call support to the 24/7 UR RN staff (telecommuters) who provide UR support to ALL campuses and each ED room. Includes any input needed for transfer center, observation units and ALL EDs.
• Assists with quarterly education to the medical staff (ED, Residents, Hospitalists) regarding documentation and level of care placement as per MCG guidelines.
• Creates, manages and maintains the 24/7 UR RN schedule and assures coverage is always available for all ED sites.
• Creates, manages and maintains the CapitalLink UR RN on call schedule, providing access for the ED MD to the on call UR RN.
• Provides coverage for all staffing shortages, including nights and weekends.
• Serves as a member of retrospective PSO adjustment team.
• Serves as primary liaison for department with finance department regarding billing discrepancies.
• Manages daily PSO cerner orders/bed day maintenance by assisting finance, logistics and patient access to assure payment issues are resolved effectively and efficiently.
• Performs other duties as need.

Physical Demands and Work Environment

• Frequent physical demands include: Sitting , Standing
• Occasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities
• Continuous physical demands include: Keyboard use/repetitive motion , Talk or Hear

Sensory Requirements

• Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks

• N/A

Ind123

• This Position Is Eligible For The Following Benefits
• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retail Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• Voluntary Life Spouse
• Voluntary Life Employee
• Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program