Top 6 Rn utilization review Jobs in Manitowoc, Wi

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- $47.50 - $71.25 an hour
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- Master of Social Work
- Nursing
- RN License
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Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler
Prevea Health —Sheboygan, WI
- CPR Certification
- Nursing
- RN License
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Manager Care Management- Sheboygan

Advocate Aurora Health -
Sheboygan, WI

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Job Details

Full-time
$47.50 - $71.25 an hour

Benefits

Paid time off

Qualifications

Computer operation
Medicare
Utilization review
Team leadership
CMS
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Utilization management
Resource utilization in healthcare
Productivity software
Discharge planning in health services social work
General management

Full Job Description

Major Responsibilities:

Provides management oversight of the daily operations of the care management and social work programs at the assigned site(s). Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services. Monitors proficiency of each site CM/SW staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies. Responsible for team building and conflict resolution.
Facilitates performance improvement activities for the care management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes. Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations. Analyzes data and information to discern root causes of performance gaps using key data and reports.
Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified. Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership and other key stakeholders.
Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for care management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc. Consults, communicates, and organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate. Participates in multidisciplinary cross functional efforts to ensure high quality, cost effective coordinated care. Works collaboratively with Physician Advisor(s) on challenging cases, removing barriers to discharge.
Accountable for site care management/social work budgets as assigned. Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives.
Ensures the care management/social work program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics. Collaborates with Compliance to ensure care management/social work program meets all state and federal guidelines.
Responsible for orientation, and ongoing competency assessment of CM/SW staff in collaboration with the Director of Inpatient Care Management Operations.
Responsible for personal professional growth. Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers. Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation.
Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

Licensure, Registration, and/or Certification Required:

Registered Nurse license issued by the state in which the team member practices, or
Social Worker license issued by the state in which the team member practices and
RN or SW: Accredited Case Manger (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or
RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or
RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or
SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year

Education Required:

Bachelor's Degree in Nursing or
Master’s Degree in Social Work

Experience Required:

Typically requires 5 years of experience in a relevant clinical setting. Includes 1 year of supervisory experience in a Care Management Leadership role.

Knowledge, Skills & Abilities Required:

Master of Nursing Administration, Master in Health Care Administration or related field preferred.
Ability to prioritize and organize work.
Ability to travel and work across multiple sites as assigned (IL or WI)
Effective communication skills.
Utilization of critical thinking in timely decision making.
Knowledge of MS Office products.
Demonstrates leadership skills.
Knowledge of Medicare A and B guidelines.
Knowledge of Managed Care programs/requirements/implications.
Knowledge of Conditions of Participation for Discharge Planning.
Knowledge of requirement elements of Utilization Management program, including support of the UM Plan.
Knowledge of Regulatory environment.
Ability to work autonomously and respond to multiple requests effectively.

Physical Requirements and Working Conditions:

Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
Manual dexterity required for operation computer and calculator.
Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately.
Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone.
Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
Exposed to normal office environment; including usual hazards related to operating electrical equipment.
Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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rn utilization review jobs in manitowoc, wi

Manager Care Management- Sheboygan

Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler

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