Internal Close Date: 05/24/2019
Requisition Number: 14688455
Position Code: 1089
Department: Utilization Management
FTE Status: 1
Position Type: BUDGETED
Shift: Days
Salary Range: Market competitive, based on experience

Internal applicants - please refer to the job description on the Compensation Department intranet site for wage rate information.

Position Summary:
Responsible for coordinating the planning, implementation and evaluation of the outpatient care management and case management programs for the University Hospitals. Responsible for the ongoing development of care management implementation strategies; monitoring and evaluation of project outcomes; and effectively communicating and integrating the mission, values and strategic initiatives of the hospitals and the Health Sciences Center. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include neonate, pediatric, adolescent, adult, and geriatric age groups.
  • PATIENT CENTERED MEDICAL HOME - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable

  • QUALITY - Participate in the assessment, development, implementation, evaluation, and attendance of educational needs for personnel based on quality assurance indicators

  • DEVELOP - Assist in the development of a care delivery system consistent with changes in patient needs, medical technology and the professions involved with specific case types

  • QUALITY - Maintain awareness of ongoing Quality Assurance studies within the unit; assist with the implementation of corrective actions determined necessary

  • COLLABORATE - Collaborate with medical staff and other personnel to plan, develop, implement and evaluate protocols, patient care policies and procedures and standards of care

  • COORDINATE - Coordinate response to external requests for presentations, site visits and consultation regarding Care Management

  • REVIEW - Perform utilization review and management, including quality review and case review for thrid party payor requirements

  • ADVISE - Advise and assist medical staff and healthcare personnel in the utilization management process

  • RECORDS - Maintain, monitor and ensure accuracy and confidentiality of patient medical records

  • EVALUATE - Evaluate and monitor utilization review process and the collection of data

  • BUDGET - Develop and recommend department operating budget and ensure that department operates within budget

  • PRODUCTIVITY - Supervise and coordinate efforts to define, monitor and improve departmental productivity

  • OPERATING PROCEDURES - Evaluate department performance and effect or recommend modifications to operating procedures as appropriate

  • DIRECTION - Organize, direct and coordinate functions and activities in department

  • PLANNING - Initiate and participate in operational and program planning, implementation and evaluation

  • POLICY - Maintain established hospital policies, procedures, objectives, quality assurance program, and safety standards

  • GOALS - Develop, implement and evaluate short and long range goals for assigned clinical area(s) in conjunction with hospital administration and department chairperson(s)

  • DIRECT - Direct the care and maintenance of department supplies and equipment

  • STAFFING - Adjust staffing to meet needs and to provide adequate coverage of department

  • PROPOSALS - Analyze potential ramifications of alternative staffing patterns, materials and equipment

  • PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols

  • PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes

  • PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk

  • PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner

  • PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"

  • SUPERVISION - Develop efficient organizational structure, supervise employees - select, terminate, train, educate, correct deficiencies, perform appraisals, issue discipline, counsel, schedule work assignments; encourage staff teamwork and growth initiatives

  • DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops

  • Education Requirements:
  • Master's Degree in related field. BSN is required if Master's is not in nursing; BSN with Master's degree in related field within 36 months

  • Experience Requirements:
  • 4 years directly related experience

  • Education Requirements - Preferred:
  • Master's in Nursing (MSN) or Doctor of Nursing Practice (DNP)

  • Experience Requirements - Preferred:
  • Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo

  • Bilingual English/Spanish

  • Physical Demands Requirements:
  • Light Work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. May require walking or standing to a significant degree or requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or may require working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of materials is negligible.

  • Testing Requirements:
  • Tuberculin Skin Test required annually

  • Working Conditions Requirements:
  • Med Haz: Mod exposure to chemicals, dangerous equipment and/or materials requiring basic safety precautions