Utilization Review Manager - Home Care jobs in Bergenfield, NJ

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positive change.

Supervises assigned staff to ensure that all case management processes are in order; including coordinating patient activities to ensure that care meets evidence-based practice standards, and regulatory/payor requirements. The role integrates and coordinates utilization management, care coordination, discharge planning functions and performance improvement activities for the case managers. The Supervisor Case Management is accountable for the department's designated staff caseload and plans effectively in order to meet staffing needs, manage the length of stay, and promote efficient utilization of resources; specific functions within this role include: a. Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. b. Application of process improvement methodologies in evaluating staff's documentation. c. Coordination of communication with physicians, nursing, and staff of ancillary departments. d. Evaluation of care provided against the Length of Stay. e. Collaboration with Admission Services to ensure accuracy of patient demographic and insurance information. f. Communication with patients and their families around medical plan of care and discharge plan, in difficult cases. g. Ensure that multi-disciplinary care conferences and afternoon 'huddles' are occurring in conjunction with Nursing. h. Supervises the staff with all case management process, including LOS, throughput, patient flow and denials and appeals follow up. i. Responsible for staff productivity and ongoing education. j. Responsible for disciplinary action and performance improvement plans when appropriate in conjunction with Manager of Case Management.

A day in the life of Supervisor Care Management at Hackensack Meridian Health includes:

• Leadership
  • Troubleshoot any issues pertinent to case management to assist in managing LOS and patient throughput.
  • Provides direction to the interdisciplinary team as needed in difficult cases.
  • Being able to obtain, interpret and present metrics related to case management to leadership and staff at Hackensack UMC.
  • Attend key meeting and present the information about existing case management processes.
  • Develops the performance enhancement plan of the case manager, documents performance provides performance feedback, evaluates the work of the employee and provides reward and recognition for proper and efficient performance. Determine areas of opportunities and suggest process improvement.
  • Documents causes for disciplinary action/counsels and coach's staff when needed and makes formal recommendations for disciplinary actions. Responds to formal and informal employee grievances and prepares written responses as required.
  • Participate in departmental preparation for JACHO.

• Coordinates/facilitates patient care progression throughout the continuum.
  • Works collaboratively and maintains active communication with physician, nursing, and other members of the multidisciplinary care team to effect timely and appropriate patient management.
  • Identifies and resolves delays and obstacles to discharge in a proactive manner. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
  • Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
  • Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

• Quality Actively participates in clinical performance improvement activities by:
  • Assisting in the collection and reporting of indicators tracking efficiency of case management processes.
  • Use of data to drive decisions and plan/implement performance improvement strategies related for assigned staff, including fiscal, clinical, and patient satisfaction data.
  • Collection of delays in service data and data for specific performance and/or outcome indicators as determined by MCG, EPIC and BI reports..
  • Collaborates with Physician Advisors,/Hospitalist in needs related to Case Management and difficult cases.
  • Attends in-service programs.
  • Participates in initiatives to improve HCAPPS scores.
  • Collaborates with social work for a seamless transfer from acute to post acute care.
  • Develops the performance improvement plan for the case manager, based on audits of the particular case manager.
  • Counsels and coaches staff.
  • Participates with MCG Annual training

• Service
  • a. Provides MCG training to the Physician advisors, Medical staff.
  • b. Reinforces MDR process within the Medical Center.
  • c. Ensures that staff have MCG training modules to review as needed.

• Growth
  • Uses MCG Guidelines as a coaching tool to aid physicians/hospitalist in appropriate placement of patients. Consults with Physician Advisor as appropriate.
  • Provides training for staff along with technical support as needed. Monitoring of caseloads for accuracy in the application of the MCG guidelines and identifying areas for process improvement in order to support the case management team.
  • MCG yearly training/implementation of IRR testing and compliance.

• Adhere to the Medical Center's Organization Competencies and the Standard of Behavior.

Education, Knowledge, Skills and Abilities Required:

• Minimum of 4 years experience in Case Management in an acute care setting.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management and PC skills.
• Current working knowledge of discharge planning, CMS regulations, case management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
• Ability to rotate on weekend/ holiday on call.

Education, Knowledge, Skills and Abilities Preferred:

• Bachelor's degree in nursing (BSN).
• RN with 4 years case management experience in acute care setting.
• Knowledge of INDICIA, EPIC and MCG.

Licenses and Certifications Required:

• AHA Basic Health Care Life Support HCP Certification.

Licenses and Certifications Preferred:

• NJ State Professional Registered Nurse License.
• Certified Case Manager.

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.