Employment TypeFull timeShiftDay ShiftDescriptionAbiding by the St. Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning, and coordination of utilization review to promote appropriate, effective and efficient use of health care resources via pre- and post-service review, appeals and program and network referrals. The scope of this position includes all medical treatment and levels of care. The Care Compass Department includes clinical care management. The department actively manages patient progression from Admission to Discharge. Through partnership and collaboration with all members of the healthcare team, the CCM's are the principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review, and medical records. In addition, they are responsible to coordinate safe and appropriate discharge plan for the patients within their service area.The Registered Nurse Manager is accountable for applying positive managerial strategies to promote the operational management of one or more clinical areas and support an environment of excellent patient care and clinical outcomes. Provides department-based leadership while engaging and promoting evidenced based practice that supports and leads department and organizational changes. Ensures compliance with all healthcare standards and requirements established by various licensing, regulatory, and accreditation bodies. Develops and implements operational plans, goals and objectives. Maintains a working knowledge of policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Supports the vision, mission and strategic plans of St. Joseph's and Trinity Health.Organization Highlights
- Our Trinity Health Culture: Our staff know, understand, incorporate & demonstrate our Trinity Health Mission, Values, Vision, through their actions, behaviors, practices & decisions.
- Leadership: Shared Governance to leaders are accessible. Unit practice counsels and open-door guiding principle for shared decision-making. All our employees have a voice.
- Well-Being: Practice in an environmentally safe, professional & healthy atmosphere. Our staff are supported by a variety of resources for physical and mental health.
- Professional Relationships: Strong rapport with our interdisciplinary team including physicians/clinical providers, rehab services, pharmacy, nutritional services and support staff.
- Professional Development: Strong education program, generous tuition allowance and clinical ladder incentives. We encourage job share opportunities to enhance satisfaction and growth.
- Work/Life: Scheduling options balance work/life/school calendars.
- Safety: Only local hospital to receive a Leapfrog A for safety.
Responsibilities
- Ensure adequate staffing plan to promote safe quality care coverage 24/7.
- Develops and evaluates department productivity plan and adjusts to reach targeted levels.
- Collaborates with finance department to develop and maintain department budget for cost effective, efficient care delivery.
- Strategic goal achievement and support.
- Coordinates response to urgent/emergent situations as evidenced by reallocation of personnel and resources.
- Collaborate with peers, physician colleagues, and administrators. Develops education for physicians and hospital departments as needed.
- Applies clinical experience, health plan benefit, structure, and claims payment knowledge to pre and post service review.
- Analyzes utilization management trends.
- Unit and organizational quality improvement and outcome-based initiatives.
- Actively participates in the utilization review committee with key hospital representatives to review utilization review information and set priorities for improvement.
- Nursing Leadership rounds and implementation of service recovery strategies.
- Coaches, mentors and supports all staff.
- Hires, evaluates, initiates corrective action and terminates employees as needed.
- Oversee staff orientation program
- Participates in patient care activities as determined by unit needs.
- Performance and staff development process.
- Performs other related duties as assigned.
- Patient and staff satisfaction.
- Ensures compliance with healthcare standards and requirements established by various licensing, regulatory, and accreditation bodies.
- Ensures quality nursing care is rendered to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing and Clinical Service standards of care and practice.
Education, Training, Experience, Certification And Licensure
- Bachelor's Degree in Nursing required with three to five years progressive experience in the field. Advanced degree is a plus/requirement, depending on specific service needs and/or requirements. Ideally the candidate will have three to five years supervisory experience.
- Graduate of an accredited School of Nursing and current licensure as a Registered Nurse in New York State.
- Specialty credentialing & educational degree according to clinical nursing practice specialty area preferred.
- Maintains all licensures and certifications according to NYS regulations and specialty area requirements.
- Participates in continuing education and updates and maintains knowledge and skills related to specific areas of expertise.
Career Advancement Opportunities
- Clinical ladder advancement with experience, staff engagement, and national certification.
- Career path to leadership roles.
Mission Statement
- We, St Joseph's Health, and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
Vision
- To be world-renowned for passionate patient care and outstanding clinical outcomes.
Core Values
- In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.
Work Environment And Hazards
- Clinical office setting. Exposure Class I
Physical Demands
- Occasional exposure to conditions which may be considered particularly disagreeable to sight, touch, sound, smell & tastes; May encounter fumes, orders, dusts, mists & gases, along with biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.); Occasionally subject to noise, infectious waste, diseases & conditions.
- Includes the need to be physically & mentally capable to perform nursing processes.
Work Contact Group
- All services, medical staff, patients, visitors, and various regulatory and professional agencies.
Supervised By
- Department Director and CNO.
The above statements are intended to describe the general nature & level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.Pay Range: $41.45 - $62.20Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.Our Commitment to Diversity and InclusionTrinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.00518237