Job Description
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 $86,964.80 - $113,672.00 Scheduled Weekly Hours 40 Position Overview Note - This is not a remote position* Performs a variety of utilization management activities to promote quality, clinical and cost-effective outcomes. Supervises activities of assigned staff in providing utilization review services. Plans, assigns, reviews, and evaluates work of assigned staff to achieve quality output, to operate in a fiscally responsible manner and 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. Performs as an effective leader. Minimum Requirements Education: Graduation from an accredited school of nursing. Experience: Three years job related experience. Five years’ experience in clinical nursing. Experience in case management field including utilization review required and/or discharge planning, outcomes management, assessment, care planning, and care coordination. Other Credentials: Registered Nurse - NJ Knowledge and Skills: Good problem solving and reasoning ability skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Special Training: Intermediate computer skills. Mental, Behavioral and Emotional Abilities: Ability to interpret a variety of instructions furnished in written, oral, graph, diagram or other format. Ability to manage multiple conflicting priorities effectively and efficiently. 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 Supervises activities of assigned staff in providing case utilization review. Acts as liaison with staff and/or management to handle any problems that arise, identifies alternatives and recommends solutions. Ensures equitable distribution of work assignment on a daily basis, adjusts work assignments throughout shift as needed and accepts staff call-outs and arranges alternate staffing as appropriate. Evaluates staff to enhance their performance, development, and work product. Addresses performance issues ongoing and through annual performance evaluations, and makes recommendations for personnel actions. Motivates and rewards employees according to company guidelines. Participates in interviewing and hiring process of new employees. Ensures quality and performance goals of individual UR RN and department - conducts regular and scheduled reviews of utilization RNs work product including reviews, payer correspondence, and other contacts and documentation. Conducts routine chart reviews for interrater reliability to maintain accuracy of reviews and maintain documentation requirements, provides ongoing feedback to utilization managers and department management regarding individual and department performance. Provides orientation and training of all new Utilization RNs, provides ongoing training and education to all staff members regarding new, evolving and/or changing workflows, timeframes and regulations. Develops training tools as necessary. Serves as liaison for department with physician advisor program, includes problem solving, orientation of new physician advisors, UR RN referral monitoring for accuracy and effectiveness. Serves as primary point of contact for providers within CH for utilization management and level of care questions or issues. Rounds in outpatient areas of responsibility several times a day to ensur