Utilization Review Manager - Home Care jobs in Buffalo, NY

Job Description

Salary: 36.06-50.43 USD

Facility: Lockport Memorial Hospital

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: SEIU Local 1199

Exempt from Overtime: Exempt: No

Work Schedule: Days with Weekend and Holiday Rotation

Hours: 8:00a-4:00p, 9:00a-5:00p, 10:00a-6:00p, 11:00a-7:00p

Summary:

The RN Care Manager, Utilization Review/ Transitions of Care, as an active member of the Care Management and interdisciplinary care team, provides comprehensive Utilization Review and transitions of care services to patients and families in the hospital setting. Utilizing foundational nursing clinical skills and discharge planning principles, the RN Care Manager, collaborates with the interdisciplinary team to maintain appropriate levels of care and to facilitate movement of the patient through the continuum. The RN Care Manager identifies and removes barriers for delays of treatment. The RN Care Manager engages the patient/patient representative in developing and implementing a post hospital plan that best meets their health and/or psychosocial needs. Our goal is to have the right care, in the right place and at the right time.

Responsibilities:

EDUCATION

• BSN degree or RN with BSW, BS Education, or BS in Health related field
• Registered Nurse, licensed ( unrestricted ) in New York State
• New York State PRI certification hospital and community required or obtained within 6 months
• Screen certification hospital and community preferred
• National Certification in Case Management preferred

EXPERIENCE

• Two years medical surgical nursing and/or job related experience
• Preferred prior insurance /managed care/utilization review experience in the role of a Care Manager or Disease Manager, Population Health , Discharge Planning or Chronic Care Manager

KNOWLEDGE, SKILL AND ABILITY

• Strong clinical assessment skills and ability to articulate findings in a fast paced environment
• Possess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approach
• Possesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and software
• Possesses case management skills critical to working on an interdisciplinary team
• Has a good understanding of the Social Determinants of Health (SDOH)
• Has good knowledge of services within the immediate community and ability to use various methods to locate those not easily identifiable
• Has a good ability to organize, prioritize and manage work in a busy hospital environment
• Possess the ability to make independent decisions when circumstances warrant such action, deal tactfully with personnel /patients, family members, visitors, etc., and seek out new methods and principles and be willing to incorporate them into existing practices
• Possess the ability to conduct a comprehensive discharge planning evaluation and create patient centered care plans

WORKING CONDITIONS:

• Willingness to work beyond normal working hours, and in other positions temporarily, and/or at other locations when necessary. Variable schedule which may include weekends and holidays. Mount St. Mary's Hospital consists of multiple locations and associate may be assigned as needed