Currently recruiting a Registered Nurse (RN) Utilization Manager near Portsmouth, Virginia to work in the Medical Management Department of Naval Medical Center Portsmouth. This is a full-time position providing care to military Active Duty heroes, their families, and retirees Full-time, 40 hrs/wk, Mon - Sat between 7AM - 7PM.
QUALIFICATIONS OF THE REGISTERED NURSE UTILIZATION MANAGER (RN):
- Degree: Associates Degree of Nursing.
- Certification as CPHQ, HCQM, CPAR or CPUM
- Education: Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). An alternative to this is to graduate from a state accredited professional nursing program.
- Possess three years of broad-based nursing experience inclusive of a minimum of one yea full-time experience within the last two years as a RN providing utilization management, discharge planning, or case management.
DUTIES OF THE REGISTERED NURSE UTILIZATION MANAGER (RN):
- Perform a full range of RN duties, including: triage; patient assessment and monitoring; appropriate nursing care, procedures, and treatments; execution of physicians’ orders; documentation of patient care and observations; and patient education and emotional support.
- Assist in the design and implementation of activities to increase staff involvement and support of an active and coordinated medical management program. Work in coordination with case management, utilization management, disease management and other members of the health care team. Primary duties shall entail provision of care and treatment of individual patients.
- Operate and manipulate automated systems such as CHCS, AHLTA, ADS, Essentris, and Clinical Information System (CIS).
- Alert physicians to significant changes or abnormalities of patients conditions, medical history and specialized treatment plan or protocol.
- Incorporate utilization review activities using the generally accepted standards and criteria for determining medical necessity, appropriateness, and reasonableness when reviewing the quality, completeness, and adequacy of health care provided to individual patients and patient populations and subsequently with similar patient populations.
- Promote collaboration and communication among all Medical Management staff, including clinical and business personnel, to promote efficient, effective, and high-quality care and services.
- Seek to reduce overutilization of Emergency Department (ED) or high cost medical settings by identifying patients with chronic diseases (e.g., diabetes, asthma, etc.) that have a significant impact on health care outcomes and costs.
- Participate in a progressively integrated approach to provision of services in coordination with Case Management and Disease Management. This approach shall emphasize the importance of facilitating environments, treatments, and procedures that generate opportunities for improved clinical outcomes and/or cost avoidance on both the individual and patient population level.
- Participate in the development of a utilization management monitoring process that provides the MTF with a “warning system” that can help identify at-risk patients (e.g. patients with diabetes, asthma, other chronic conditions, etc.) at the earliest opportunity for intervention, such as during the preadmission and concurrent review processes. For example, patients with specific diseases/ conditions scheduled for admission to the hospital can be identified and referred as potential candidates for Case Management or Disease Management services. As necessary, facilitate proactive discharge planning to help address such patients’ post- hospitalization needs.