Manager Utilization Review Utilization Resource Mgmt Trenton NJ

Position: Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
## Manager Utilization Review - FT
- Day
- Utilization Resource Mgmt Trenton NJApplylocations:
RMCtime type:
Full time posted on:
Posted Todayjob requisition :
JR110460

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a
** full-time equivalent (1.0 FTE)
** position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
** Pay Range:**$97,947.20 - $
** Scheduled Weekly

Hours:

** 40
* * Position Overview**#  Please note - this is not a remote position Performs a variety of utilization review activities to promote quality, clinical and cost-effective outcomes, including evaluation of length of stay and resource consumption. Manages activities of assigned staff in the process of providing utilization review. Plans, assigns, reviews and evaluates the work of assigned staff to achieve quality patient care, to operate in a fiscally responsible manner, 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.

MINIMUM REQUIREMENTS

Education:

Bachelor of Science in Nursing (BSN). An Associate Degree in Nursing (ADN) and additional years of experience may be considered in lieu of a BSN.

Experience:

Four years of experience in nursing, including experience in the case management field in utilization review, discharge planning, outcomes management, assessment, care planning and/or care coordination when accompanied by a BSN. Six years of experience in nursing, including experience in the case management field in utilization review, discharge planning, outcomes management, assessment, care planning and/or care coordination when accompanied by an ADN.  

Other Credentials:
Registered Nurse - NJ  Knowledge and

Skills:

Excellent interpersonal, communication and negotiation skills with ability to convey understanding of complex issues. Ability to interpret a variety of instructions furnished in written or oral form. Strong organizational and time management skills. Strong leadership, motivational and team building skills.  Special Training:
Analytical and data management skills.  Mental, Behavioral and Emotional Abilities:
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  Performs all daily Utilization Review Functions, includes communicates with payers, performs clinical reviews utilizing the appropriate guidelines, policies, and timelines. Identifies, develops, and implements strategies to facilitate appropriate length of stay and resource consumption.  Supervises utilization review staff to ensure that appropriate processes are followed according to CH policy and utilization guidelines.  Ensures equitable distribution of work assignment on a daily basis.

Adjusts work assignments throughout shift as needed. Accepts staff call-outs and arranges alternate staffing as appropriate. Ensures that appropriate staffing level are maintained through proactive planning.  Conducts routine reviews of utilization staff work product including reviews, payer correspondence, and resource management documentation to identify opportunities to enhance compliance with documentation requirements.  Provides ongoing feedback to utilization review director regarding department performance.  

Acts as liaison with the administrative staff to handle any problems that arise. Advises director when physician or patient issues require legal, ethical, or administrative interventions.  Attends system level meetings and represents utilization review services in order to promote and develop good working relationships. Participates in system wide committees as assigned, such participation should also enhance knowledge of and about UR.  

Provides for effective function of department by interviewing, hiring and training new utilization management staff.  Provides for ongoing function of department by assessing educational needs and providing training and ongoing…