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Nurse Supervisor, Utilization Review

salary Salary :

$98,301 - 157,227 yearly

icon building Company : Evergreenhealth
icon briefcase Job Type : Full Time
icon geo-alt Kirkland, Washington

Job Description - Nurse Supervisor, Utilization Review


Description



Wage Range: $98,301 - $157,227 per year

 
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity. 
 
 
Who We Are
We focus on care coordination with patients/families and work closely with members of the interdisciplinary staff to assure that each patient receives the right care in the right setting at the right time. Our care teams are composed of the following:              
  • Social Workers provide crisis intervention, behavioral health and chemical dependency assessments, screen for abuse and neglect, as well as coordinate post-discharge care. We help coordinate with skilled nursing facilities, home health, hospice, arrange for equipment, and arrange for additional services in the community.
  • Utilization Management/Case Management Nurses provide clinical information to our payers and ensure that patients are meeting medical necessity for acute services. They also partner with the Social workers in coordinating post-discharge care.
  • Clinical Documentation Specialists review documentation to ensure that the patient experience is being documented accurately. They partner with the physicians to reflect the appropriate severity of illness and level of service provision.
 
Job Summary
Working under department management, specializes in assessing hospital admissions for status per defined criteria and reviews for appropriate utilization of resources. Ensures continuity and coordination of care for patients before, during and after hospitalization, and ensures that payer conditions are met.
 
 
Primary Duties:
  1. Under the direction of the department Director/Manager of Care Management, supervises the day-to-day activities of the Care Management RNs.
  2. Coordinates the staff schedules including vacation/holiday requests and weekend rotations.
  3. Coordinates daily assignments
  4. Functions as a resource to staff for clinical problem solving.
  5. Provides employee feedback as needed and performs probationary and annual performance appraisals.
  6. Participates in policy and guideline updates.
  7. Facilitates orientation of new employees.
  8. Follows and reinforces Medicare guidelines to ensure compliance with appropriate admission orders (i.e. Observation, Extended Recovery, Inpatient, Outpatient etc.)
  9. Communicates regularly with department Director/Manager to provide updates on status of projects or issues and other necessary feedback.
  10. Continually evaluates patient flow and provides intervention to facilitate patient care in an optimal timeline.
  11. Oversees utilization review process including education, support, and training of team members to ensure standardization and support on difficult cases.
  12. Anticipates problems and obstacles in care coordination and applies appropriate problem-solving skills to prevent or reduce delay in patient care/discharge.
  13. Provides leadership and continuity of care guidance and support for patients with chronic diseases and/or complex disease states as they receive care throughout the care continuum.
  14. Uses knowledge of illness, diagnoses, and treatments in comprehensive, holistic assessments of patients.
  15. In conjunction with the interdisciplinary team supervises progress and recommends appropriate clinical interventions to nursing staff and attending physicians, supporting compliance with Center for Medicare and Medicaid Services guidelines.
  16. In conjunction with the interdisciplinary team ensures that patients and families have access to resources for post-hospital care needs.
  17. Monitors the patients’ medical progress, identifies and addresses patient needs/gaps in service as they move through the system, and obtains authorization for discharge planning.
  18. Takes action to correct variances in length of stay and address them in care progression rounds; follows up with physicians and payors as needed.
  19. Oversees utilization reviews, meeting all time requirements and addresses the discharge appeal process in collaboration with the Director/Manager and/or Social Worker/RN Case Manager.
  20. Performs other duties as assigned
 
 
 
License, Certification, Education or Experience:
 
 
REQUIRED for the position:
  • Bachelor of Science degree in Nursing
  • 2 years acute care or case management experience
  • Current State of Washington RN license
  • Current Healthcare Provider BLS – American Heart Association by start date
  • Knowledge of the healthcare financial environment, reimbursement, and levels of care.
  • Maturity and interpersonal skills necessary to lead and coordinate an interdisciplinary team and deal effectively with patients and families from a variety of backgrounds and with varied emotional and medical needs.
  • Verbal and written language skills; visual and aural skills to communicate, ensure and deliver safe patient care and to provide a legal record of this care.
 
DESIRED for the position:
  • Master’s degree in nursing
  • 5 years of experience as an RN
  • Previous leadership experience
  • Case Management Certification from ACMA
 
 
At EvergreenHealth our staff our proud to work for an organization that has received national recognition for the following:
  • Named one of American’s 50 Best Hospitals in 2024, one of the only hospitals in the Seattle* area (Seattle, Tacoma, Bellevue, WA CBSA) to receive this designation.
  • Named by Becker's Hospital Review among the nation's 100 great community hospitals for 2024 for improving the health of their communities, staying focused on personalized care and clinical excellence. 
  • In 2023 EvergreenHealth was one of two hospitals that received the Patient Safety Excellence Award throughout the states of WA, ID, OR, MT, and Alaska
 
 
Benefit Information: 
Choices that care for you and your family
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff, and their loved ones maintain and improve health and financial well-being.
  • Medical, vision and dental insurance
  • On-demand virtual health care
  • Health Savings Account
  • Flexible Spending Account
  • Life and disability insurance
  • Retirement plans 457(b) and 401(a) with employer contribution)
  • Tuition assistance for undergraduate and graduate degrees
  • Paid Time Off/Vacation
  • Extended Illness Bank/Sick Leave
  • Paid holidays
  • Voluntary hospital indemnity insurance
  • Voluntary identity theft protection
  • Voluntary legal insurance
  • Pay in lieu of benefits premium program
  • Free parking
  • Cafeteria & Gift Shop Discount
 
View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.
 
 NUR321
#LI-EK1
 
 
 
 


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