Utilization Management Transfer Center RN_Acute | Reno, NV

team to facilitate, promote, and coordinate high quality, individualized, safe and cost-effective acute transfers to and from Renown Health. #Monitors and coordinates resource utilization throughout the health system and evaluates services needed or being provided by the sending facility.

##Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (Inter Qual Intensity of Service, Severity of Illness criteria). ##Concurrently intervenes to enhance patient quality outcomes where appropriate. ##Reviews clinical information in the medical record reflecting the patient#s true severity of illness through interfacing with the patient#s

care team or physicians to facilitate potential patient transfer. # # This position also provides information (certified LOS and reimbursement issues) to the care team (RN, physicians, and case manager) as needed to ensure the appropriate and timely disposition of the client.

# The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially avoidable/non-reimbursed days, quality indicators (such as readmissions). Delivers non-covered letters as set forth by payer and/or regulatory compliance. # This position will be required to work a flexible schedule that may include weekends to provide coverage for the department as needed. This position

participates in Quality Improvement initiatives. # Knowledge, Skills # Abilities # 1.

Strong interpersonal communication skills both verbal and written. 2. Knowledge of applicable regulatory requirements and community resources 3. Knowledge of continuous quality improvement process. 4. Philosophy consistent with the strategic plan of Renown Health 5. The ability to understand and resolve complex problems in a timely and effective manner using critical thinking skills. 6. The ability to keep current with new developments and acquire the needed knowledge for the position in order to keep skill sets up to date. 7. The ability to work under stress and to meet deadlines.

# This position does not provide patient care. # # # Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. # # # Minimum Qualifications Requirements - Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada.

Bachelor of Science in Nursing preferred. Experience: Applicants with 1 year previous managed care and/or case management experience including acute hospital case management is preferred. Minimum of one-year in acute hospital nursing care setting required. License(s): Ability to obtain and maintain a State of Nevada Registered Nurse license or ability to obtain and maintain Registered Nursing licensure in state of residency. Certification(s): A minimum of 1 year of Utilization Management required. Additional Case Management experience is preferred.

Computer / Typing: Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. # #Position Purpose This position promotes appropriate utilization, high quality care and cost-effective outcomes for Renown Health Acute Transfers. This role is works in the Renown Transfer and Operations center to enhance collaboration and communication regarding incoming and outgoing transfers. Nature and Scope Collaborates with an interdisciplinary team to facilitate, promote, and coordinate high quality, individualized, safe and cost-effective acute transfers to and from Renown Health.

Monitors and coordinates resource utilization throughout the health system and evaluates services needed or being provided by the sending facility. Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (Inter Qual Intensity of Service, Severity of Illness criteria). Concurrently intervenes to enhance patient quality outcomes where appropriate. Reviews clinical information in the medical record reflecting the patient's true severity of illness through interfacing with the patient's care team or physicians to facilitate potential patient transfer.

This position also provides information (certified LOS and reimbursement issues) to the care team (RN, physicians, and case manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially avoidable/non-reimbursed days, quality indicators (such as readmissions). Delivers non-covered letters as set forth by payer and/or regulatory compliance.

This position will be required to work a flexible schedule that may include weekends to provide coverage for the department as needed. This position participates in Quality Improvement initiatives. Knowledge, Skills & Abilities1. Strong interpersonal communication skills both verbal and written.2. Knowledge of applicable regulatory requirements and community resources3. Knowledge of continuous quality improvement process.4. Philosophy consistent with the strategic plan of Renown Health5. The ability to understand and resolve complex problems in a timely and effective manner using critical thinking skills.6.

The ability to keep current with new developments and acquire the needed knowledge for the position in order to keep skill sets up to date.7. The ability to work under stress and to meet deadlines. This position does not provide patient care. Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications Requirements - Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing and speaking English.

Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada. Bachelor of Science in Nursing preferred. Experience: Applicants with 1 year previous managed care and/or case management experience including acute hospital case management is preferred. Minimum of one-year in acute hospital nursing care setting required. License(s): Ability to obtain and maintain a State of Nevada Registered Nurse license or ability to obtain and maintain Registered Nursing licensure in state of residency.

Certification(s): A minimum of 1 year of Utilization Management required. Additional Case Management experience is preferred. Computer / Typing: Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.