Utilization Review Manager - Home Care jobs in Connecticut

Job Detail

Job Title:Clinical Case Manager- (Utilization Review)

Department:Case Management

Location:Farmington

FTE%:1

Shift2

Search #:2023-1278

Closing Date:05/21/2023

Recruiter:McNamara, Elizabeth

Additional Links:

This position is in salary group UHP-11; click here to review the current UHP Pay Plan

UConn Health is looking for a highly skilled RN Clinical Case Manager with experience in acute healthcare and a passion for patient experience. This highly desirable position is located at the John Dempsey Hospital.

 

Benefits of this position include:

Competitive pay structures

Industry leading, affordable access to medical, dental, vision, life and retirement benefits

Tuition waivers and reimbursements for self and dependents

Easy access to I-84, Rte 9 and surrounding Greater Hartford communities

Organizational culture focused on diversity and inclusion, innovation and patient experience

State of the art, award winning campus environment with ideal parking

 

SCHEDULE: Full time, 40 hours per week, 3:00 p.m. to 11:30 p.m., minor holidays with major holidays and weekends as needed. 30 minute unpaid meal break

 

MINIMUM QUALIFICATIONS, KNOWLEDGE, SKILLS, ABILITIES:

Knowledge of the principles and practices of case management.

Knowledge of: various disease modalities and expected and adverse outcomes of therapeutic interventions.

Knowledge of standards of practice for interdisciplinary delivery of patient care,

Excellent interpersonal and oral and written communication skills.

Problem solving skills and the ability to establish priorities and manage effectively;

Ability to elicit relevant information and cooperation of patients and staff, and to adapt teaching methods to individual needs.

Supervisory ability.

 

EXPERIENCE AND TRAINING

 

GENERAL EXPERIENCE: Master's degree in Nursing

SUBSTITUITION ALLOWED: Bachelor's degree in nursing with three years' experience in an inpatient hospital setting or Case Management experience.

 

PREFERRED REQUIREMENTS:

Minimum 2 years case management experience.

Experience of utilization review regulations and tools such as InterQual, Milliman.

 SPECIAL REQUIREMENTS: Incumbents in this class must maintain licensure as a registered nurse

 

EXAMPLES OF DUTIES:

 

Assess patient/family clinical status needs related to medical diagnosis, treatment plan, treatment providers, treatment options, financial resources and discharge planning needs.

Facilitates and secures all post-acute care referrals for homecare, DME, LTACH, Hospice and skilled nursing facilities.

Facilitates transitions within the hospital as well as direct admissions and transfers from other facilities as it relates to clinical bed management.

Interprets critical data and makes recommendations to effect improvement in outcomes based on trends in inappropriate, inefficient or costly utilization.

Intervenes to suggest creative options for inappropriate admissions; documents case manager intervention and comparison to established criteria for medical necessity.

Establishes ongoing dialogue with patient/family to determine if patient's needs are being met.

Monitors critical aspects of care affecting reimbursement.

Provides point of contact for community physicians, staff, payers and patient regarding plan of care and questions related to discharge and resource utilization.

Develops collaborative relationships with home care agencies or post-acute facilities to provide appropriate clinical documentation (e.g., PPS) and to support quality patient care.

Performs other related duties as required.

Performs a full range of tasks related to discharge planning and utilization review.

Collects data and performs audits related to discharge planning and utilization review.

  

FULL TIME EQUIVALENT SALARY MINIMUM: $87,194

 

Why UConn Health

 

UConn Health is a vibrant, integrated academic medical center that is entering an era of unprecedented growth in all three areas of its mission: academics, research, and clinical care. A commitment to human health and well-being has been of utmost importance to UConn Health since the founding of the University of Connecticut schools of Medicine and Dental Medicine in 1961. Based on a strong foundation of groundbreaking research, first-rate education, and quality clinical care, we have expanded our medical missions over the decades. In just over 50 years, UConn Health has evolved to encompass more research endeavors, to provide more ways to access our superior care, and to innovate both practical medicine and our methods of educating the practitioners of tomorrow. 

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