Job Description

LOCATION:  WICKENBURG, AZ

 

Wickenburg Community Hospital is a beautiful and sophisticated rural-access hospital located in Wickenburg, Arizona.  WCH is a 8-bed Emergency Department, 19-bed Acute department and many ancillary services.  We also have 3 Primary Care Clinics.  Here at WCH, we strive to maintain the highest standards of professionalism and care.  Join us today and let us be part of your success story.

We offer:

  • Full Benefits
  • PTO/Sick Leave
  • Wellness Benefits

Wickenburg Community Hospital is a non-profit organization and qualifies for the Public Service Loan Forgiveness (PSLF) program.

General Description 

The Utilization Management RN role will perform the duties of Utilization Management by demonstrating a multidisciplinary approach to identifying problems, communicating and negotiating with the patient’s PCP, family members, caregivers, and other members of the health care team, community resources and the Health Plans.

Essential Job Duties 

  • Works in conjunction with Case Management, Quality and other healthcare professionals to demonstrate a multidisciplinary approach in identifying problems, communication and negotiating with the patient’s PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans.
  • Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family.
  • May collect and report utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, as applicable.
  • Completes appropriate, accurate and timely, documentation into EMR system.
  • Reports questionable admissions, level of care, length of stays to the Director of Nursing, Clinical; reports quality of care issues to the Medical Director.
  • Is an active member of the Medical Care Review Committee representing Utilization Management as required by regulatory agencies.
  • Documentation in the EMR which is timely and accurate
  • Reviews documentation of providers and nursing to ensure required documentation is being completed to meet qualification of appropriate admissions.
  • Completes daily admit MCG qualifiers for admitted patients and provides report to registration to submit to insurers.
  • Meets with the Providers and /or Directors to provide real time education on opportunities of documentation based on regulations.
  • Coordinates, develops agendas, gathers appropriate information, and leads the UR meetings in compliance with state regulations.
  • Effectively communicates and collaborates with the multidisciplinary teams, providers, Case Management, and Acute Director.
  • Provides back-up for Case Manager’s as indicated and Case Managers will provide back-up for the UR RN; example during vacation or planned day off to ensure MCG are being completed and reported to appropriate department as indicated and/or SWING Bed intake is completed in a timely manner during the absence of CM.
  • This is not an all-inclusive list and is subject to change as indicated and approved by the employee and Patient Care Services Director.

Other Duties 

  • Participation in daily multidisciplinary team meetings
  • Provide support to patients and families who face the challenge of healing
  • Create forms necessary for accurate and thorough documentation

Minimum Qualifications 

  • Current RN license
  • 3 years nursing experience
  • Requires the ability to manage programs and projects.
  • Requires demonstrated excellence in interpersonal and written communication skills.
  • Experience with software applications and tools

Preferred Qualifications 

  • Previous experience with discharge planning and/or case management
  • Previous experience with Utilization Management and review
  • Previous EMR experience

Physical Requirements/Working Conditions 

May be subjected to offensive odors and combative behavior.    May be exposed to communicable diseases including the HIV and HBV viruses.  Must be able to work paying close attention to detail with frequent interruptions.  Must be able to work independently with minimal supervision.

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