Utilization Coordinator

 

Organization:

SSRRH-Sutter Santa Rosa Reg Hospital

Position Overview:

The Utilization Coordinator is responsible for coordinating admissions, performing concurrent and retrospective utilization review, and facilitating discharge planning. The Coordinator applies InterQual criteria to all patient admissions to assure that patient care is provided in the appropriate setting. S/he performs concurrent and retrospective utilization review to assure that the appropriate level of care is maintained throughtout the patient's hospital stay. S/he also provides coordination of complex discharge planning needs and referrals to appropriate support services.

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Job Description:

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES

Applies InterQual criteria to all patient admissions to assure that patient care is provided in the appropriate setting.

Performs concurrent and retrospective utilization review to assure that the appropriate level of care is maintained throughtout the patient’s hospital stay.

Follows up with insurance companies to provide information to justify continued patient stays

Provides coordination of complex discharge planning needs and referrals to appropriate support services.

Coordinates patient movement to the next appropriate care setting.

Assures that all healthcare team members are working toward the same patient care goals.

Assures that any DME, specialized equipment, or Home Health care is arranged as ordered.

Participates in the identification, collection, and analysis of data to support Utilization Management (for example, activities affecting patient length of stay, such as avoidable days) and Performance Improvement.

Documents all admission, concurrent and retrospective review, and discharge planning activities in the medical record.

Applies critical-thinking skills and problem solving techniques to the admission and discharge processes.

Accurately conducts a thorough and objective assessment of the patient’s continued stay, including, as needed, psychosocial and financial needs.

Partners with physicians for effective clinical management and utilization of resources for the patient population.

Maintains current knowledge of disease processes, available resources and treatment options appropriate to patient population.

Consistently demonstrates excellent communication and interpersonal skills.

EDUCATION
Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: BSN

CERTIFICATION & LICENSURE

RN-Registered Nurse of California

CCM-Certified Case Manager within 90 Days of hire

OR CPUM within 90 Days of hire

OR CPUR within 90 Days of hire

PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN:

2 years experience working in Utilization Management (admissions, utilization review, and/or discharge planning).

SKILLS AND KNOWLEDGE

Knowledge of InterQual criteria

Community resources and community programs

JCAHO standards, Title 22, CMS Conditions of Participation and other applicable regulations

Good interpersonal and communications skills

Ability to work under the general supervision of the director, with a minimum of direction

Strong clinical assessment and critical thinking skills

Time management skills

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Variable

Weekend Requirements:

Rotating Weekends

Benefits:

Yes

Unions:

Yes

Position Status:

Non-Exempt

Weekly Hours:

32

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $67.62 to $89.74 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

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