Utilization Management Nurse

Presidential Staffing Solutions, LLC

Los Angeles, CA

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JOB DETAILS

SKILLS

Case Management, Certified Case Manager (CCM), Communication Skills, Computer Skills, Cost Analysis, Customer Support/Service, Dental Insurance, Discharge Plans, Educational Administration, Geriatrics, Graphics Software, Health Insurance, High Reliability, Information Technology & Information Systems, Information/Data Security (InfoSec), Interpersonal Skills, Leadership, Medical Records, Medical Treatment, Medicine, Microsoft Office, Nursing, Organizational Skills, Outpatient Care, Patient Care, People Management, Performance Management, Policy Development, Policy Implementation, Problem Solving Skills, Procedure Development, Quality Management, Quality of Care, Registered Nurse (RN), Reporting Skills, Resource Utilization, Special Needs, Spreadsheets, Standards of Care, Team Player, Time Management, Training/Teaching, Treatment Evaluation, Utilization Management, Vision Plan, Word Processing

LOCATION

Los Angeles, CA

POSTED

30+ days ago

Benefits:

401(k)
Competitive salary
Dental insurance
Health insurance
Paid time off
Signing bonus
Training & development
Vision insurance

Competitive Compensation
Great Work Environment
Career Advancement Opportunities

Job Summary
We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we are running at optimal efficiency, and that all patients under our care are receiving the necessary treatments and procedures. The ideal candidate has deep experience in a similar medical setting, has a bachelor's or higher in Nursing, and has a certification in either Case Management or Utilization Management.

Responsibilities

Review patient files and treatment information for efficiency
Monitor the activity of staff to ensure effective patient treatment
Advocate for quality patient care to prevent complications
Review discharge information for outgoing patients
Work closely with clinical staff to provide excellent patient care
Prepare reports on patient management and cost assessments

Dimensions of Nursing Practice
PRACTICE: Knowledge of professional nursing practice and the ability to apply the nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) with close supervision.
Expectations:
1. Completes orientation according to expected standards.

2. Works with close supervision, is responsible and accountable for individual nursing practice and seeks direction from others as needed.

3. Manages workload as assigned, organizes, and completes own assignments in an efficient and appropriate manner.

4. Participates in the development, implementation, and evaluation of interdisciplinary care.
5. For Inpatient RNs, performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs.

VETERAN/PATIENT DRIVEN CARE: Knowledge of Veteran/patient driven care, patient experience, satisfaction, and safety.
Expectations:
1. Establishes a therapeutic relationship, allowing the patient to attain, maintain or regain optimal function through assessment and treatment.

2. Engages patients, families, and other caregivers to incorporate knowledge, values, and beliefs into care planning without judgement or discrimination.

3. Knowledgeable of ethical issues related to professional nursing practice and follow established policies of the practice setting, VA, and ANA Code of Ethics for Nurses.

4. Aware of high reliability principles to deliver consistent care and improve patient outcomes.

LEADERSHIP: Communicates, collaborates, and utilizes leadership principles to perform as an effective member of the interprofessional team.
Expectations:
1. Demonstrates positive, effective communication skills and professional behaviors that promote cooperation and teamwork with internal and external customers.

PROFESSIONAL DEVELOPMENT: Incorporates educational resources/opportunities and self-evaluation for professional growth.
Expectations:
1. Participates in unit based educational activities and continuing education requirements.

2. Responsible for maintaining competency to continue personal and professional growth.

EVIDENCE-BASED PRACTICE/RESEARCH: Awareness of evidence-based practice/research to improve quality of care and resource utilization.
Expectations:
1. Applies evidence-based practice/research to patient care.

2. Participates in unit-based activities to improve and deliver cost effective patient care.

3. Demonstrates knowledge of specific unit level performance improvement activities.

4. Incorporates patient preferences into shared care delivery decisions.

Customer Services Requirements: The incumbent meets the needs of the Veteran and as appropriate the Veteran’s family, caregiver and/or significant other, the Veteran’s representative, visitors to VA facilities, all VA staff and other customers while supporting VA missions. The incumbent consistently communicates and treats the Veteran and as appropriate the Veteran’s family, caregiver and/or significant other, the Veteran representatives, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner. The incumbent provides the Veteran’s family, caregiver and/or significant other, the Veteran’s representative, visitors to VA facilities, all VA staff, and other customers with consistent information according to establish policies and procedures. The incumbent handles conflict and problems in dealing with any consumer group appropriately and in a constructive manner.

Age, Development, and Cultural Needs of Patients Requirement: The primary age of Veterans treated is in their middle years (ages 40 to 50) or at the geriatric level (ages 60 or older). There are occasionally younger patients between the ages of 25 to 40 years of age that require care. The position requires the incumbent to possess or develop an understanding of the particular needs of these types of patients. Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors must be consistently achieved. Computer Security Requirement: The incumbent protects printed and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, Federal regulations, VA statutes and policy, and VHA policy. The incumbent protects the data from unauthorized release or from loss, alteration, or unauthorized deletion. Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the computer access agreement that the incumbent signs. Reports all known information security incidents or violations to the supervisor and/or the Information Security Officer immediately. Reports all known privacy incidents or violations to the Privacy Officer immediately. Compliance is measured by supervisory observation and periodic random monitoring by the Information Security Officer or Office of Information Technology staff. Major violations such as loss of or unauthorized release, alteration, or deletion of sensitive data are unacceptable.

Other Significant Information: This position potentially requires flexibility in schedule and assignments. For RN Inpatient Case Management staff, there may be rotation to 0830-1700 from the initial 0630-1500 (Monday – Friday)

Qualifications:

BSN and/or MSN preferred.
Minimum of 5 years of successful nursing practice, encompassing education, administration, leadership, and Quality Management Performance Improvement (QM/PI) experience preferred.
Basic computer literacy proficiency with the use of Microsoft Office programs or comparable word processing, spreadsheet and graphic software and the ability to learn new programs specific to the VA preferred.
Ability to work variable and flexible tours to meet program demands.
Demonstrated ability to accurately implement policies, regulations, standards of care and standards of practice preferred.
Demonstrated ability to review patient clinical records.
Proven ability to facilitate group problem solving preferred.
Proven ability to utilize sound judgment in making patient transfer decisions preferred.
Ability to lead and effectively direct staff within program unit/team/group preferred.
Excellent organizational, communication, writing, and time management skills preferred.
Excellent interpersonal skills and the ability to work independently as well as collaboratively with multiple service lines and disciplines preferred.

Utilization Management Nurse

Presidential Staffing Solutions, LLC

Los Angeles, CA

About the Company

Presidential Staffing Solutions, LLC

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