Utilization Management Coordinator Non RN

Description

Job Description

PeaceHealth is seeking a Utilization Management Coordinator Non RN for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $31.60 – $47.40. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

Coordination of the organization's clinical documentation and utilization management. Coordination of care across the continuum. Collaborates and coordinates communication and decisions across the health care team to achieve national standards for best practices, discharge planning, clinical documentation and utilization management functions. Coordinates discharge planning and implementation.

Essential Functions

• Review medical records for determination and documentation of medical necessity for inpatient and/or observations status utilizing established criteria and methods.
• Identifies issues and variations in utilization and escalates to appropriate members of the health care team. Actively support measures that promote effective use of resources.
• Develops and coordinates discharge plans with input and involvement of health care team. Incorporates priorities and decisions made by patient. Implements discharge plans in partnership with staff RNs.
• Identifies patients at risk for encountering problems post hospitalization and collaborates with Social Services for referral to appropriate discipline team members and outside agencies to support optimum success.
• Advocates for Services and funding as appropriate and necessary to meet care plan goals.
• Identify, plan and arrange for appropriate services applying knowledge of services available in the community, state, and federal health regulations and admission, discharge and medical necessity criteria.
• Facilitates process to support patient’s ability to access and utilize resources that best meet their needs and eligibility criteria.
• Demonstrates knowledge of procedures which assure quality care and effective utilization of hospital services; applies this knowledge when coordinating discharge plans and reviewing medical records.
• Monitor the individual’s condition and responsiveness to their interventions.
• Performs other duties as assigned.
  
  

Qualifications

Education

• Bachelor's Degree Preferred: in related field or 5 years clinical experience in an acute care setting
  
  

Experience

• Minimum of 1 year Preferred: Current practical experience in utilization management, risk management, quality improvement and
• Preferred: Experience in discharge planning and social services
  
  

Credentials

• Preferred: Social Worker Licensure and
• Preferred: Certified Case Manager
  
  

Skills

• Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities. (Required)
• Excellent skills in conceptual thinking, listening, problem resolution and planning. (Required)
• Demonstrated leadership skills. (Required)
• Excellent organizational skills. (Required)
• Proficient computer skills including MS Office applications and electronic medical records. (Required)
• Knowledgeable about issues related to chronic illness, developmental disabilities, special needs, mental illness, grief and transition, substance abuse, domestic violence, child abuse and senior abuse. (Required)
• Good understanding and adherence to core social work values and ethics. (Required)
  
  

Working Conditions

Lifting

• Consistently operates computer and other office equipment.
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
• Sedentary work.
  
  

Environmental Conditions

• Predominantly operates in an office environment.
• Some time spent on site in medical/hospital setting.
  
  

Mental/Visual

• Ability to communicate and exchange accurate information.
• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.
  
  

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.