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Department: Utilization Management FTE: 1.00 Full Time (30 - 40 hours per week) Shift: Days
Position Summary: Responsible for coordination, implementation and evaluation of Care Management for UNM Hospital. Responsible for the case management delivery and monitoring quality for care management staff. Provide care management services for UNM Hospital when necessary. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include neonate, pediatric, adolescent, adult, and geriatric age groups.
Detailed responsibilities: * QUALITY - Participate in the assessment, development, implementation, evaluation, and attendance of educational needs for personnel based on quality assurance indicators * COLLABORATE - Collaborate with medical staff and other hospital personnel to plan, develop, implement and evaluate protocols, patient care policies and procedures and standards of care * COORDINATE - Coordinate response to external requests for presentations, site visits and consultation regarding Care Management * REVIEW - Perform utilization review and management, including quality review and case review for third party payor requirements * SUPERVISION - Develop efficient organizational structure, supervise employees - select, terminate, train, educate, correct deficiencies, perform appraisals, issue discipline, counsel, schedule work assignments; encourage staff teamwork and growth initiatives * DATA - Perform assessment, data collection, obtain, review, and analyze information in collaboration with the patient, family, significant others, health care team members, employers, and others as appropriate * COLLABORATION - Develop collaborative relationships with other departments/services and community health care agencies facilitating and supporting quality care in area of clinical expertise; act as a resource on complex patient care activities * LEADERSHIP - Provide leadership in case management through identification of problems and opportunities for improvement, program planning, implementation, and evaluation * ORIENTATION - Participate in orientation, continuing education of Care management staff and other health care team members as appropriate * COMMUNICATION - Use interpersonal communication strategies with individuals as well as groups of patients, families, significant others, and staff to achieve expected outcomes and patient/family and health care team satisfaction * DIRECTION - Organize, direct and coordinate functions and activities in department * EVALUATE - Evaluate and monitor utilization review process and the collection of data * POLICY - Maintain and revise as necessary hospital policies, procedures objective to maintain quality assurance program, and safety standards * STAFFING - Adjust staffing to meet needs and to provide adequate coverage of department * PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols * PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes * PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk * PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner * PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right" * SUPERVISION â Provide Clinical Supervision to RN Case Managers, conduct random chart reviews and ensure appropriate distribution of assignments
Education: Essential: * Master's Degree Nonessential: * Master's Degree Education specialization: Essential: * Related Discipline (BSN required if not MSN) Nonessential: * Nursing
Experience: Essential: 2 years directly related experience
Nonessential: 3 years directly related experience
Credentials: Essential: * RN in NM or as allowed by reciprocal agreement by NM * Case Manager Certification w/in 1 year * CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
Physical Conditions: Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Working conditions: Essential: * Minor Hazard - physical risks, dirt, dust, fumes, noise * May be required to travel to various work sites * May perform subordinate tasks in high census/vol * May be required or is required to perform on-call duties * May work rotating shifts, holidays and weekends