Utilization Management Director jobs in Adolph, MN

Compassion. Accountability. Collaboration. Foresight. Joy.

These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.

Aspirus is currently seeking a Utilization Review Nurse. These positions could be located at any Aspirus UP facility including Aspirus Keweenaw, Aspirus Ironwood, Aspirus Iron River and Aspirus Ontonagon.

Duties include:

• Monitors, evaluates and assists in the maintenance and improvement of efficient utilization of hospital resources through performance of pre-admission/admission and continued stay medical record reviews.
• Responsible for coordinating communication between the hospital and third-party payors to ensure care delivered in the hospital setting will be reimbursed.
• Minimizes denials by third-party payors by communicating clinical information in a timely manner.
• Intervenes to reduce and eliminate service delays and non-acute hospital days.
• Monitors the quality of documentation and services provided and makes recommendations for improvement.
• Keeps current with all government rules and regulations (federal and state) that impact the Utilization Review program; evaluates their impact on needed operational changes and communicates this information on a timely basis to all appropriate departments.
• Performs concurrent chart review hospital-wide in accordance with department protocol and productivity standards and maintains documentation on all cases.
• Treats all information obtained while completing the review process or carrying out the other aspects of the Utilization Review program with strict confidentiality.
• Identifies opportunities to improve the environment of care, and patient and staff safety. Participates in projects and programs designed to create a safe environment to avoid error.

Hours: This position is occasional, 0 FTE. Day shift. Extended days, current hours 8-4:30, subject to change based on need. Weekend coverage as needed.

• Knowledge of utilization review standards and patient care practices normally acquired through graduation of an accredited school of professional nursing.
• A minimum of two years of acute care hospital experience.
• Associate degree in Nursing

Education – Preferred

• Bachelor’s degree in nursing
• Successful completion of quality or Utilization Review certification examination
• Active membership in professional organization (i.e., NAHQ, WAHO)

Experience

• Experience in critical care, general medical and/or surgical nursing.
• Experience in educational presentations.
• Experience in the application of Utilization Review activities and medical record reviews.

Required

• Possesses an active RN State nursing license.

Other

• Possesses independent work habits, is self-reliant and self-directed.
• Possesses the ability to learn, adapt, and change as required by the job functions.
• Able to work effectively in situations of high stress and conflict and communicate the goals and outcomes of case management.
• Possesses general understanding and knowledge of:
• Medicare system
• Utilization review principles and objectives
• Managed care indicators
• Quality Improvement principles and Risk Management objectives
• Possesses and exercises good public relations skills.
• Possesses strong clinical skills, assessment and good professional judgment, as well as broad-based knowledge of medical management, nursing management and medical terminology.
• Demonstrates the ability to read and comprehend government regulations and contracts.
• Demonstrates familiarity and knowledge of medical records organization and procedures.

Employee Benefits

• Full benefits packages available for part- and full-time status.
• PTO accrual from day one!
• Generous retirement plan with match available.
• Wellness program for employees and their families.

Our Mission: We heal people, promote health and strengthen communities.

Our Vision: Aspirus is a catalyst for creating healthy, thriving communities, trusted and engaged above all others.

As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities.

Aspirus Health is a non-profit, community-directed health system based in Wausau, Wisconsin. Its 11,000 employees are focused on improving the health and well-being of people throughout Wisconsin and Upper Michigan. Aspirus serves communities through four hospitals in Michigan and 13 hospitals in Wisconsin, 75 clinics, home health and hospice care, pharmacies, critical care and air-medical transport, medical goods, nursing homes, and a broad network of physicians.