Registered Nurse -Utilization Management Per Diem

Employment Type:

Part time

Day Shift

Day shifts. Hybrid - partial local remote

Position

Purpose:

The Registered Nurse Utilization Review (UR), Clinical Care Manager (CCM) actively manages the utilization review process and patient progression from Admission to Discharge. Through partnership and collaboration with all members of the healthcare team, the UR/CCM is the principal liaison between emergency services, surgical services, nursing, finance, physicians, and medical records. In addition, they are responsible to coordinate safe and appropriate discharge plan for the patients within their service area.

• Completes initial and follow up case reviews on all patients as dictated by payer and status.
• Uses Interqual and Indicia/MCG software and Physician Advisors to determine appropriate patient status/level of care and ensure timely transition of care from admission to discharge.
• Follows Medicare guidelines and industry standards to ensure the proper patient class is assigned.
• Leads daily SNAP huddles and works collaboratively with unit staff and support team (RN, Physician/Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to progress each patient's care towards discharge.
• Performs Initial Stay reviews.
• 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.
• Maintains current knowledge of basic health care economics, trends and reimbursement methodologies and applies knowledge to daily practice. Recognizes situations that require immediate intervention. Continues to develop professionally and apply knowledge and skills necessary to provide care appropriate to each patient.

• Graduation from an accredited school of nursing and current licensure in the State of New York.
• Bachelor’s degree in nursing preferred, according to NYS requirements, with one to two years progressive experience in the field. Ideally the candidate will have strong clinical skills, leadership qualities and must be actively working toward an advanced degree.
• 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.

• Our Trinity Health Culture: Our staff know, understand, incorporate & demonstrate our Trinity Health Mission, Values, Vision, through their actions, behaviors, practices & decisions. Our Unit practice counsels, and open-door guiding principle gives all our employees a voice.
• Professional Environment of Care: Practice in an environmentally safe, professional & healthy atmosphere. Only local hospital to receive a Leapfrog A for safety.
• Benefits: Comprehensive benefit packages available through Trinity Health, including medical, dental, vision, paid time off, 403B, and education assistance.
• Professional Development: Strong education program, generous tuition allowance and clinical ladder incentives. We encourage job share opportunities to enhance satisfaction and growth. We encourage participation and support community programs and outreach.
• Work/Life: Scheduling options to balance work/life/school and recreational calendars.

Located in the heart of central New York, St. Joseph’s is one of America’s 50 Best Hospitals for Cardiac Surgery and one of America’s 100 Best for Spine Surgery and Coronary Intervention according to Health grades. It is ranked by Consumer Reports among the top 15 heart surgery centers in the country, a designated Stroke Center, a U.S. News “Best Regional Hospital” and “Best Maternity Hospital”.

With a comprehensive range of primary-care practices, mental health services, women’s and infants' care, and oncology services, St. Joesph’s Health network offers a wide range of innovative, community-based health and wellness programs. Our high-quality specialty and mental…