Collaborates and coordinates with all members of the healthcare team, patient and family (or significant others) to coordinate and ensuretimely and efficient delivery of required workflow, services and tasks toresult in:
Support of positive patient health care outcomes
Increased patient/health care team outcomes and satisfaction
Improved inpatient throughput and appropriate length of stay
Improved communication, awareness and adherence to regulatory requirements associated with utilization
Support for inappropriate level of care and decreased inpatient bed day denials
Continuity and coordination of care
Appropriate and timely authorization for level of care
Performs timelyand accurate admission and continued stay review in accordance with departmentpolicy to ensure efficient use of hospital resources, timely discharge andoptimal, appropriate reimbursement (includes communication with internal andexternal customers).
Collaborates and coordinates with all members of thehealth care team, patient and family (or significant others) to promote timelyand effective communication, completionof workflow and services with regard to level of care decisions and payerdecisions regarding continued stay.
Documents review activity, including but not limited to,application of criteria or policy as appropriate, clinical review to submit toinsurance providers, initiation of registration changes when appropriate, outcomesand cost savings in a manner consistent with department requirements.
Meets department productivity and quality standards.
*This role may encounter Protected Health Information (PHI)as part of regular responsibilities. UHemployees must abide by all requirements to safely and securely maintain PHIfor our patients. Annual training, theUH Code of Conduct and UH policies and procedures are in place to addressappropriate use of PHI in the workplace.
This is a PRN as needed position to support the Utilization Management department at UH Cleveland Medical Center.
Hours vary based on department need, candidates must have Monday - Friday availability along with the ability to cover weekends and holidays as needed.
3yrs RN clinical acute care experience required, along with 2yrs clinical experience working with the patient population to be served required.
Additional experience in sub-acute setting or managed care preferred
Must have sound clinical knowledge base of population to be served required
Experience with Interqual or Milliman criteria preferred
Case Management software proficiency preferred
Knowledge of Medicare, Medicaid and commercial payer preferred
Graduate of an accredited nursing position, bachelor's degree preferred
Current RN licensure in the State of Ohio
Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity