Department: Utilization Management FTE: 1.00 Full Time (30 - 40 hours per week) Shift: Days
The Clinical Advancement Program (CAP) is additional pay to recognize Nursing Education and National Certifications and can add to pay.
Sign on Bonus and Relocation Reimbursement for external Candidates.Â
Position Summary: Responsible for the initial review, triage and assignment of patients to case managers and for the coordination of all systems and services required for an organized, multidisciplinary, patient centered care team approach. Assure quality, cost effective care for the identified patient population. Supervise staff in the department. Acts as a resource and role model for staff. The incumbent also functions as a contact person for the patient, family, health care team members, community resources and employees. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include Neonate, Pediatric, Adolescent, Adult and Geriatric age groups.
Detailed responsibilities: * PATIENT CENTERED MED - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable * IDENTIFICATION - Identify appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review, risk screens, and referral * 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 * ASSESSMENT - Assess the patient's clinical, psychosocial status and current treatment plans * NEEDS - Assess the patient/family/significant others needs in relation to the medical diagnosis and treatment and resources; provide treatment options, financial resources, psychosocial needs, and discharge planning in collaboration with appropriate resources * 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 * ASSIGNMENT - Oversee and assign case loads and staff hours to best suit Hospitals needs * COVERAGE - Organize case coverage during absence of staff * PERFORMANCE - Assist in developing standards of performance, evaluation of performance, and initiates or makes recommendations for personnel actions * LEADERSHIP - Provide leadership through identification of problems and opportunities for improvement, program planning, implementation, and evaluation * GOALS - Assist the patient, family, significant others to set patient-centered goals for individual patient, family, and significant others in collaboration with physicians, staff RNs and other health care team members * PLAN OF CARE - Develop comprehensive multidisciplinary plan of care effectively utilizing tools and resources * DISCHARGE PLANNING - Conduct timely discharge planning by anticipating patient needs in collaboration with physicians, staff RN's, and other health care team members * VARIANCES - Intervene when variances occur in patient individualized treatment plan * RESOURCES - Coordinate and evaluate the use of resources and services in a quality-conscious, cost effective manner and collaborate with appropriate providers to ensure effective, quality outcomes * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review, maintaining interdependent follow-up as necessary * VARIANCE - Review variance from standardized protocols of care with health care team members and implement resolution strategies * TREATMENT CONFERENCE - Facilitate and/or participate in conferences providing ongoing evaluation of interdisciplinary dynamics, goals attainment and treatment management * EDUCATION - Ensure and/or provide instruction to the patient and family based on identified learning needs; assess patient/family knowledge, health status expectations, and locus of control * INFORMATION - Assist with development of activities and methods to ensure information is articulated and disseminated to appropriate members of the health care team * CONTINUITY OF CARE - Collaborate with the health care team to ensure continuity of patient care throughout all health care settings; promote effective communication among health care team members including the patient, family, and significant others * MEETINGS - Participate in team meetings when indicated or as directed * CARE PLAN - Incorporate recommendations and/or services of interdisciplinary team members in the care plan * 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 * DOCUMENTATION - Provide routine verbal and written documentation for the initial assessment and progress of the patient to other members of the health care team in a timely manner * ORIENTATION - Participate in orientation, continuing education of staff RN's and other health care team members as appropriate * RELATED WORK - Perform related duties and responsibilities as required * ADMINISTRATION - Perform various administrative functions such as monitoring expenditures and preparing reports and correspondence; may participate in a variety of research projects to develop service plans; may propose changes to program policies and procedures * DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops * STAFF - Assist in interviewing, hiring, orienting, training, coaching, evaluating, counseling, and supervising staff * 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"
Experience: Essential: 3 years directly related experience
Nonessential: Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo
Credentials: Essential: * RN in NM or as allowed by reciprocal agreement by NM * CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
Physical Conditions: Light Work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. May require walking or standing to a significant degree or requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or may require working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of materials is negligible.
Working conditions: Essential: * Sig Hazard: Chemicals, Bio Hazardous Materials req PPE