FT-RN Case Management/Utilization Review Team Lead

North Carolina Specialty Hospital (NCSH), is a private, physician-owned medical center that opened its doors in 1926. North Carolina Specialty Hospital's commitment to growth and continuous improvement has helped the hospital maintain a number of high rankings in both quality measures and patient satisfaction.  North Carolina Specialty Hospital offers surgical specialties in orthopedics, ophthalmology, ear, nose and throat as well as sports medicine, oral, plastic, podiatry, general surgery, interventional radiology, pain management, reconstructive surgery and more.

Why join North Carolina Specialty Hospital?

• Award Winning Hospital for Special Surgery
• 5 Star CMS rated facility for patient experience
• Positive Work culture
• Career growth opportunities
• Comprehensive Medical, Dental, Vision Insurance, Life and Disability Insurance
• Telemedicine/You have access to Physicians 24/7/365 through MDLIVE
• Paid Time Off
• 401k Employer Match
• Tuition Assistance

Job Summary

Team Lead/supervisory role within the Performance Outcomes department. Coordinate patients in the healthcare continuum to achieve optimal clinical, financial, operational and satisfaction outcomes. Act in a liaison function with the interdisciplinary healthcare team to promote and/or facilitate utilization of medical services. Identify and intervene when necessary to ensure efficient and cost-effective delivery of patient care services. Establish and promote collaborative relationships with physicians, patients, families, and additional members of the healthcare team. Educate members of the healthcare team on utilization review and managed care concepts. Act as a resource for routine and complex problem solving as it relates to utilization review and case management. Anticipate the needs of customers and work proactively to improve services. Work with others to improve customer satisfaction and participates in special projects as needed.

Essential Job Functions

• Assists with coordination of hospital activities concerned with case management and utilization review.

• Adhere to departmental goals, objective, standards of performance, and policies and procedures.

• Demonstrates the spirit of the philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment.

• Performs other duties as required or assigned, which are reasonably within the scope of duties in this job classification.

• Manages the daily operations of the NCSH Utilization Review Plan

• Monitors compliance with regulatory standards as well as supervises the professional practice of the Utilization
  Review/CM staff

• Assists with the orientation of new hires

• Possesses expert knowledge in utilization criteria and regulatory documentation requirements
• Functions across the healthcare continuum, interfacing with professionals from a multitude of disciplines to facilitate the best possible clinical outcomes and promote financial stewardship
• Acts as an advocate for the Utilization Review/CM team, making sure the Clinical Manager/Director is aware of the
  unique needs of the team
• Provides leadership for the UR/CM team by overseeing staff, fielding daily concerns, participating in the process improvement initiatives, overseeing education of team and providers, and fostering collaborative relationships
• Assists the Director by ensuring proper staffing and coverage; monitoring and evaluating departmental and organizational expectations; and providing feedback, input, and supportive documentation during annual performance evaluations
• Serves as member, resource, and liaison to the Interdisciplinary Care Team
• Serves as a consultant to other departments or organizations as needed
• This role assists in triaging identified issues/problems and forming resolution within the scope of work/licensure
• Serves as a formal and informal instructor and escalates issues/concerns to the appropriate person when outside of scope
• Ensures adequate/appropriate distributions of workload and assignments
• Monitors staff performance including productivity and compliance with regulatory requirements, compliance with policies, and identifies, communicates, and coaches to improve staff performance
• Serves as the primary resource for all business-related questions/issues raised by staff; escalates appropriately to the Director when necessary
• Recommends and implements process improvement measures to achieve department's performance measures outcomes and goals
• Plans and oversees UM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members
• Serves as a leader and role model as well as informational resources to staff and peers
• Fosters a culture that encourages employee contribution and growth, to ensure that the department maintains an environment that supports quality
• Maintains positive working relationships and fosters cooperative work environment.

• Managing the inpatient population throughout a 30 day episode of care

• Application of process improvement methodologies in evaluating outcomes of care

• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patients' progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

• Able to gather clinical information from the EMR and perform telephonic post-discharge follow-up to determine risk of readmission or the requirement of additional medical services.

• Refers cases and issues to the Director of Performance Outcomes and follow up as needed.

Training & Education

• Graduate of an accredited school of professional nursing required.  BSN preferred.
• Current RN licensure in the state of North Carolina required.
• Current state license as an RN. Basic Life Support (BLS) certification required through ARC or AHA accredited program.
• Must be able to communicate and understand the English language both verbal and written.

Experience:

• 2-3 years' experience as an RN in hospital setting.
• Experience in utilization review, coding, or case management preferred.
• Supervisory/charge experience preferred

Skills & Abilities:

• Able to work independently and meet established deadlines.
• Able to make sound reasonable decisions.
• Highly organized.
• Ability to concentrate on many detailed requests.
• Demonstrates accountability, professionalism, openness, receptive to change, creativity and innovative.
• Ability to identify and calmly handle inherently stressful situation with tact.
• Effective communication skills; both orally and written
• Ability to develop excellent working relationships with consumers and staff.
• Seeks guidance, direction and assistance when needed.
• Computer skills needed.
• Ability to work with others within a team to ensure quality patient care.
• Strong critical thinking skills.

Our employees are critical to our success, and we value their contributions. North Carolina Specialty Hospital offers a competitive compensation and benefits package and an opportunity to grow and develop your career in an environment that values employee ideas and diversity. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled. We maintain a drug-free workplace and require pre-employment drug screening and background check.