Utilization Management Coordinator

PeaceHealth

Job Description

Description

PeaceHealth is seeking a Utilization Management Coordinator for a per diem role in Care Management at Southwest Medical Center in Vancouver, Washington. In this per diem role you will work 8-hour day shifts to provide additional support to the department when needed. Ideal candidate will have a healthcare related degree with a Social Worker or Licensed Practical Nurse background that includes utilization review/care management functions.

Hourly compensation starts at $27.78, more depending on experience.

JOB SUMMARY

Coordination of the organization’s clinical documentation and utilization management.Coordination of care across the continuum.Collaborates and coordinates communication and decisions across the health care team to achieve national standards for best practices, discharge planning, clinical documentation and utilization management functions.Coordinates discharge planning and implementation.

ESSENTIAL FUNCTIONS

  • Review medical records for determination and documentation of medical necessity for inpatient and/or observations status utilizing established criteria and methods.

  • Identifies issues and variations in utilization and escalates to appropriate members of the health care team.Actively support measures that promote effective use of resources.

  • Develops and coordinates discharge plans with input and involvement of health care team.Incorporates priorities and decisions made by patient.Implements discharge plans in partnership with staff RNs.

  • Identifies patients at risk for encountering problems post hospitalization and collaborates with Social Services for referral to appropriate discipline team members and outside agencies to support optimum success.

  • Advocates for Services and funding as appropriate and necessary to meet care plan goals.

  • Identify, plan and arrange for appropriate services applying knowledge of services available in the community, state, and federal health regulations and admission, discharge and medical necessity criteria.

  • Facilitates process to support patient’s ability to access and utilize resources that best meet their needs and eligibility criteria.

  • Demonstrates knowledge of procedures which assure quality care and effective utilization of hospital services; applies this knowledge when coordinating discharge plans and reviewing medical records.

  • Monitor the individual’s condition and responsiveness to their interventions.

  • Other duties as assigned.

QUALIFICATIONS

EDUCATION:

  • Bachelor’s degree in related field preferred or 5 years clinical experience in an acute care setting.

EXPERIENCE/TRAINING:

  • Minimum of one year current practical experience in utilization management, risk management, quality improvement preferred.

  • Experience in discharge planning and social services preferred.

LICENSE/CERTIFICATION:

  • Current Washington State LPN or Social Worker licensure preferred.

  • Certification in Case Management highly desired.

OTHER SKILLS:

  • Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.

  • Excellent skills in conceptual thinking, listening, problem resolution and planning.

  • Demonstrated leadership skills.

  • Excellent organizational skills.

  • Proficient computer skills including MS Office applications and electronic medical records.

  • Knowledgeable about issues related to chronic illness, developmental disabilities, special needs, mental illness, grief and transition, substance abuse, domestic violence, child abuse and senior abuse.

  • Good understanding and adherence to core social work values and ethics.

SOUTHWEST PHYSICAL/COGNITIVE REQUIREMENTS

  • Work requires fairly light physical exertion up to 66% of the time.

  • Ability to lift objects weighing 30 lbs. or less.

  • Work is performed under normal working conditions with adequate lighting and ventilation.

  • Job duties frequently require intense concentration and attention to detail (34-65% of work time).

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

REQNUMBER: 1347

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