Nurse Clinician - Utilization Management - 60%

The University of Iowa Hospitals & Clinics within the Continuum of Care Division, Utilization Management Team is looking for a Nurse Clinician to functions as a clinical nurse expert and clinical coordinator acting as nurse liaison to physicians, patients and administration.
Candidate will clinically review and facilitate changes in level of care, based on systematic evaluation, utilization management and evidence-based research.
Incorporating Milliman care Guidelines in each review.
This position will strive to achieve quantitative measures of success across the UIHC Hospitals, including Stead Family Hospital and University of Iowa Healthcare.
Position Responsibilities Analyze initial and ongoing assessment data to determine diagnoses and determine appropriate level of care.
Collaborates in the implementation of patient care plans and follow-up care coordination for patients within the primary care clinics.
Facilitate patient-centered clinical assessment and care coordination throughout the healthcare continuum, working with multiple members of the health care team, from the Emergency Room, Nurse Navigators as well as Providers.
Collaborate with health care professionals (managers, administrators, schedulers, internal and external providers, and other care coordinators) to facilitate smooth transitions of care.
Provide clinical information to relevant clinical team members regarding patient needs and/or newly identified issues, specifically working with the Utilization Management team.
Serve as clinical resource to social services and other providers/care coordinators, specifically regarding the compliance portion of the level of care.
Uses judgment and expertise to apply and adopt information within total clinical picture to address patient health issues.
Coordinate and facilitate patient care between multiple disciplines including home health agencies, referring physicians and other community support services.
Facilitates continuity of care.
Communicate with physicians and members of the health care team directing patient care.
Autonomously communicates with referring physician Participate in the development and implementation of disease-specific management programs with associated educational and clinical resources to support the patient/family/staff.
Serves as an educational and clinical resource to clinics, patients, families, staff, and the community.
Develop educational resources (verbal and printed) based on evidence-based practices to ensure improved patient and family understanding.
Provide education regarding primary care information not only at a clinical level, but at times an institutional and/or community level approved by the Director of Population Health | ACO Operations and Population Health Medical Director.
Conduct chart reviews to evaluate care practices and deficiencies.
Per chart review, prepares and presents educational program for nursing staff at that level of care.
Develops & presents educational materials to inpatient units approved by the Nurse Manager.
Conducts quality improvement initiatives within the care setting under the direction of the Nurse Manager.
Use relevant nursing research to improve clinical practice and investigate nursing care problems as evidence by reviewing updates in the Milliman Care Guidelines.
Maintain an understanding of third-party coverage with respect to Medicare, Commercial and Medicaid policies and procedures.
Responsible for maintaining clinical expertise consistent with patient population requirements and current nursing and medical practice.
Collaborates with nursing staff and other health care professionals in the development and review of standards and apply these standards when planning, implementing, and evaluating patient care for the primary care population.
Adheres to professional and legal standards of nursing practice.
Maintains confidentiality of patient and staff information.
Maintains effective working relationships with faculty, staff, students, and the public.
Seek opportunities to enhance one's own knowledge, skills, and abilities within the clinical coordinator role, recognizing its contribution to the mission and goals of the institution.
Exhibits good teamwork is approachable, cooperative, and contributes to an overall positive and productive work/team environment.
Demonstrates the core values of service leadership: respect, communication, accountability, integrity, and compassion.
Demonstrates respect for all members of the University community in the course of performing one’s duties and in response to administrators, supervisors, coworkers, and customers.
Works effectively with individuals from all backgrounds.
Welcomes the richness of talent from a diverse workforce and recognizes that diversity brings stimulation, challenge, and energy that contribute to a productive and effective workplace.
Represents the interests of the University and of unit leadership in the use of resources to meet service and productivity demands within unit goals and budgets; strives to promote continual process and quality improvement.
Seeks opportunities to enhance one’s own professional knowledge, skills, and abilities as they relate to one’s current position and/or to prepare for potential future roles and overall career development.
Listens to feedback without defensiveness and uses it to enhance communication effectiveness.
Remains calm and constructive in conflict situations, listens and attempts to understand other points of view.
Communicates in alternative ways to accommodate different listeners.
Performs other special projects and tasks as assigned.
Percent of Time: Part time, 60% Schedule: Monday - Friday 7:30am- 4:00pm shift This position is eligible for remote work within Iowa and will require a work arrangement form to be completed upon the start of your employment.
Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location.
Pay Grade: https://hr.
uiowa.
edu/pay/pay-plans/seiu-pay-plan Benefits Highlights: Regular salaried position located in Iowa City, Iowa Fringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plans For more information about Why Iowa?, click here Required Qualifications A Baccalaureate degree in Nursing is required.
Current license to practice nursing in Iowa is required by date of hire.
1-3 years of recent clinical health care experience including care coordination Demonstrated experience coordinating care along the healthcare continuum Proficiency in computer applications including Microsoft Excel, Word, and PowerPoint Demonstrated excellence in critical thinking, organizational skills, independent decision-making, time management, prioritization, and problem-solving skills Excellent written and verbal communication skills Experience working in an interdisciplinary team.
Desired Qualifications Experience with care coordination for patients across the spectrum of different specialties.
Demonstrated expertise spanning pediatric, adult, and geriatric care.
Ability to work independently as well as within a team.
Demonstrated experience in providing education to multiple stakeholders.
Excellent written and verbal communication and interpersonal skills are required.
Experience working with case management; utilization management; insurance contracts or knowledge of CPT and ICD-9/10 codes or clinical guideline systems such as Milliman© InterQual© or other similar system.
Certification in a role or specialty through a nationally recognized professional nursing certification body is desired.
Experience and knowledge with Medicare Guidelines of outpatient observation and 2 midnight rule is desired.
Position and Application details: In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” to the submission: • Resume • Cover Letter Job openings are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended.
Successful candidates will be required to self disclose any conviction history and will be subject to a criminal background check and credential/education verification.
Up to 5 professional references will be requested at a later step in the recruitment process.
For additional questions, please contact seton-vinsand@uiowa.
edu