Utilization Management RN
Huggins Hospital | Wolfeboro, NH
The Employer has temporarily removed this postingUnder the general supervision of the UM Manager, is responsible for performing technical and administrative work required to evaluate the necessity appropriateness, and efficiency of utilization of medical services, procedures, and resources in collaboration with the Medical Staff. Supports Huggins Hospital's Utilization Management Program utilizing clinical knowledge, expertise, and criteria guidelines, to include all aspects of admission and continued stay review of all patients in the Observation, Med Surg and Intensive Care Units.
1. Provides excellent customer service through all interventional activities
2. Implements utilization review procedures by prospectively, concurrently, and retrospectively assessing the clinical information against pre-established criteria guidelines, and protocols for pre-admissions, scheduled admissions, emergency care, scheduled surgery, and outside referrals.
3. Monitors and facilitates appropriate utilization of resources
4. Assigns and monitors lengths of stay for all admissions
5. Collaborates with appropriate disciplines to coordinate authorization of scheduled and unscheduled admissions and observation assignments
6. Supports multi-disciplinary strategies to reduce length of stay, reduce consumption of resources and achieve positive patient outcomes
7. Educates the Medical Staff and Nursing Staff on Utilization Management
8. Functions as a resource to physicians and nursing staff regarding approved criteria, practice guidelines, and alternative treatment options
9. Participates with the multidisciplinary team in formulating possible solutions to problems identified
10. Maintains clinical expertise in specialty area/or general nursing
11. Provides assistance regarding clinical issues to non-nursing utilization review staff
12. Coordinates and orchestrates Corporate Compliance Plan and Program at Huggins Hospital and serves as Chair of Corporate Compliance Committee