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Utilization Mgmt Coordinator
3 months ago
**Overview**
Founded in 1955 Dignity Health - Northridge Hospital Medical Center is a 394-bed acute care nonprofit community hospital located in Northridge California. The hospital offers a full complement of award winning services including the Leavey Cancer Center a cardiovascular center stroke center the Center for Assault Treatment Services a pediatric medical center and the only pediatric trauma center in the San Fernando Valley. As a leading provider of compassionate high-quality and affordable patient-centered care we share a rich legacy with Dignity Health one of the nation’s five largest health care systems. We are part of a 21-state network of nearly 9000 physicians 62000 employees and more than 400 care centers. Visit dignityhealth.org/northridgehospital for more information.
The RN Utilization Management Coordinator (UMC) is responsible for assessing planning facilitating and advocating for options and services through a continuum of care from point of contact through discharge on assigned patients.The RN UMC performs this role in such a manner as to meet the individuals health needs while promoting quality and cost effective outcomes. The position emphasis will be on care coordination communication and collaboration with nursing physicians therapy services insurers and post acute service providers to pace the care toward optimal outcomes within the appropriate level of care. The RN UMC will provide oversite to the interdisciplinary team to ensure a smooth plan of care. The UMC participates in development and promotion of service line represents Behavioral Health Care services and participates in interdepartmental meetings and work teams. The UMC will advocate for the patient and family by identifying and valuing patient choice spiritual needs cultural language and socioeconomic barriers to care transitions. In addition the UMC will protect confidentiality while striving to achieve high levels of patient satisfaction.
LI-DH
**Responsibilities**
- The UMC evaluates the medical necessity of a patients utilization of healthcare services with designated screening criteria upon point of admission and throughout the provision of care in accordance with and in compliance of the Behavioral Health Dignity Health Utilization Review Policy.
- The UMC will participate on the Behavioral Health appeal process if necessary
- The UMC facilitates the development of a multidisciplinary plan of care, engaging other relevant health team members, the patient or patient representative and post acute care providers in accordance with the patients clinical or psychosocial needs, choices and available resources. The UMC coordinates patients appropriate care transition and discharge process when not performing UM role
- The UMC participates regularly in Medical Center's departamental, hospital team meetings and performance improvement and when necessary will participate in data collection and reporting.
- This position requires the full understanding and active participation in fulfilling the Mission of the Organization. It is expected the UMC will demonstrate behavior consistent with the Core Values of the organization.
- The UMC is accountable for staying current with and seeking knowledge of hospital policies, standards of practice and Federal or State regulations pertaining to their practice.
- In addition, this position considers the population served by the medical center and area clinical integration programs and leads efforts to optimize care coordination across the care continuum. This coordination ensures a plan of care for patients in all stages of health needs.
**Qualifications**
- Minimum of 3 years nursing experience in an acute hospital setting required.
- Current CA Registered Nurse (RN) license
- Prior Utilization Management experience in a clinical or insurance setting required.
- Previous Psychiatric nursing experience preferred.
- Excellent customer service and presentation skills are a must.
- Strong interpersonal and written communication skills are essential.
- Demonstrated ability to manage multiple tasks or projects effectively.
- Ability to work independently as needed with a high degree of detail orientation.
- Ability to work efficiently in a fast-paced environment with changing priorities
- Case Management certification preferred.
- LA City Fire Care required within 90 days of hire.
**Pay Range**
$48.00 - $72.61 /hour
