Utilization Mgmt Supervisor- Full Time

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Pay Range:

Scheduled Weekly Hours:

Position Overview

Education:Graduation from an accredited school of nursing.

Experience:Five years of job related experience. Previous experience in clinical nursing. Experience in case management field including utilization review and/or discharge planning, outcomes management, assessment, care planning, and care coordination.

Other Credentials:Registered Nurse - NJ

Knowledge and Skills:Good problem solving and reasoning ability skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Special Training:Intermediate computer skills.

Mental, Behavioral and Emotional Abilities:Ability to interpret a variety of instructions furnished in written, oral, graph, diagram or other format. Ability to manage multiple conflicting priorities effectively and efficiently.

Usual Work Day:Exempt Hours  

Does this position formally supervise employees? Yes

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

• Supervises activities of assigned staff in providing case utilization review.
• Acts as liaison with staff and/or management to handle any problems that arise, identifies alternatives and recommends solutions.
• Ensures equitable distribution of work assignment on a daily basis, adjusts work assignments throughout shift as needed and accepts staff call-outs and arranges alternate staffing as appropriate.
• Evaluates staff to enhance their performance, development, and work product. Addresses performance issues ongoing and through annual performance evaluations, and makes recommendations for personnel actions. Motivates and rewards employees according to company guidelines.
• Participates in interviewing and hiring process of new employees.
• Ensures quality and performance goals of individual UR RN and department - conducts regular, scheduled reviews of utilization managers work product including reviews, payer correspondence, and other contacts and documentation. Conducts routine chart reviews for interrater reliability to maintain accuracy of reviews and maintain documentation requirements, provides ongoing feedback to utilization managers and department management regarding individual and department performance.
• Provides orientation and training of all new Utilization Managers, provides ongoing training and education to all staff members regarding new, evolving and/or changing workflows, timeframes and regulations. Develops training tools as necessary.
• Serves as primary liaison for department with physician advisor program, includes problem solving, orientation of new physician advisors, UR RN referral monitoring for accuracy and effectiveness.
• Serves as primary point of contact for providers within CH for utilization management and level of care questions or issues. Rounds in outpatient areas of responsibility several times a day to ensure timely and accurate exchange of information and reviews.
• Provides on call support to the 24/7 UR RN staff (telecommuters) who provide UR support to ALL campuses and each ED room. Includes any input needed for the transfer center, observation units and ALL EDs.
• Provides quarterly education to the medical staff (ED, Residents, Hospitalists) regarding documentation and level of care placement as per MCG guidelines.
• Creates, manages and maintains the 24/7 UR RN schedule and assures coverage is always available for all four ED sites. Creates, manages and maintains the Capitalink UR RN on call schedule, providing access for the ED MD to the on call UR RN.
• Provides Coverage for all staffing shortages, including nights and weekends.
• Serves as a member of the retrospective PSO adjustment team. Serves as primary liaison for the department with the finance department regarding billing discrepancies. Manages the daily PSO cerner orders/bed day maintenance by assisting finance, logistics and patient access to assure payment issues are resolved effectively and efficiently.

Frequent physical demands include: Sitting , Standing
Occasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities
Continuous physical demands include: Keyboard use/repetitive motion , Talk or Hear
Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks Include the following: N/A

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.