Utilization Management Nurse Specialist

6 days ago


Los Angeles, California, United States Presidential Staffing Solutions, LLC Full time
Job Summary

We are seeking a highly skilled Utilization Management Nurse to join our team at Presidential Staffing Solutions, LLC. As a Utilization Management Nurse, you will play a critical role in ensuring the efficient and effective delivery of patient care.

Key Responsibilities
  • Review patient files and treatment information to identify opportunities for improvement
  • Monitor staff activity to ensure effective patient treatment and optimize resource utilization
  • Advocate for quality patient care to prevent complications and ensure positive outcomes
  • Review discharge information for outgoing patients to ensure seamless transitions
  • Collaborate with clinical staff to provide excellent patient care and achieve optimal results
  • Prepare reports on patient management and cost assessments to inform strategic decision-making
Dimensions of Nursing Practice
  • PRACTICE: Apply the nursing process (assessment, diagnosis, outcome identification, planning, implementation, and evaluation) to deliver high-quality patient care
  • Expectations:
    • Complete orientation according to expected standards
    • Work collaboratively with others to achieve shared goals
    • Manage workload effectively and prioritize tasks to meet deadlines
    • Participate in the development, implementation, and evaluation of interdisciplinary care
    • Perform unit-based inpatient case management duties, including RN case management assessments and discharge planning
Veteran/Patient Driven Care
  • Knowledge of Veteran/patient driven care, patient experience, satisfaction, and safety
  • Expectations:
    • Establish a therapeutic relationship with patients to promote optimal function and well-being
    • Engage patients, families, and caregivers to incorporate their knowledge, values, and beliefs into care planning
    • Knowledgeable of ethical issues related to professional nursing practice and adhere to established policies and guidelines
    • Aware of high reliability principles to deliver consistent care and improve patient outcomes
Leadership
  • Communicate effectively with internal and external customers to promote cooperation and teamwork
  • Utilize leadership principles to perform as an effective member of the interprofessional team
Professional Development
  • Participate in unit-based educational activities and continuing education requirements
  • Responsible for maintaining competency to continue personal and professional growth
Evidence-Based Practice/Research
  • Aware of evidence-based practice/research to improve quality of care and resource utilization
  • Apply evidence-based practice/research to patient care
  • Participate in unit-based activities to improve and deliver cost-effective patient care
Customer Service Requirements
  • Meet the needs of the Veteran and their family, caregiver, and/or significant other
  • Communicate and treat the Veteran and their family, caregiver, and/or significant other in a courteous, tactful, and respectful manner
  • Provide consistent information according to established policies and procedures
Age, Development, and Cultural Needs of Patients
  • Understand the particular needs of patients across the lifespan, including middle-aged and geriatric patients
  • Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors
Computer Security
  • Protect printed and electronic files containing sensitive data in accordance with applicable laws and regulations
  • Report all known information security incidents or violations to the supervisor and/or the Information Security Officer immediately


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