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UnityPoint Health Utilization Management in Fort Dodge, Iowa

UnityPoint Health - Fort Dodge

Utilization Management Coordinator

FTE: .4 (part-time, 16 hours per week)

Shifts: 16 hours per week; Monday-Friday

UM Coordinator Responsibilites

· Maintains a working knowledge of requirements of payers across the continuum.

· Possesses an ongoing commitment to monitor resource consumption throughout the patient stay.

· Collaborates and communicates with all members of the health care team regarding patient LOS, payer constraints and authorizations.

· Demonstrates commitment to performance improvement efforts on an ongoing basis.

· Maintains knowledge and is accountable for accurate patient level of care.

· Completes continued stay reviews for medical necessity.

· Reviews, evaluates and participates in completing any referred denials or appeals.

· Educates the health care team about utilization management concepts

· Maintains knowledge of criteria used in admission and discharge process.

· Participates in organizational and unit activities that contribute to patient safety, quality outcomes, and patient satisfaction.

Basic UPH Performance Criteria

· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

· Demonstrates ability to meet business needs of department with regular, reliable attendance.

· Employee maintains current licenses and/or certifications required for the position.

· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

· Completes all annual education and competency requirements within the calendar year.

· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Education:

Associate Degree of Nursing. Bachelors’ of Science in Nursing preferred.

Experience:

Minimum of five-(5) year’s broad-based clinical experience required. Preferable clinical experience will be in specialized case management area.

License(s)/Certification(s):

Current RN Licensure in State of Iowa or applicable compact state. Must be licensed in state of residence. Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Must demonstrate effective communication skills. Ability to delegate wisely, exercise good judgment, maintain effective interpersonal relationships, adapt to change, evaluate critically and think creatively. Must demonstrate knowledge and skills required for specialized area of assignment. Basic Life Support certification.

Other:

Electronic mechanical record, computer, fax machine, electronic and mechanical patient care equipment, office equipment and access Web for patient resources.

PROTECTIVE EQUIPMENT: gloves, gowns, masks

Requisition ID: 2021-86259

Street: 802 Kenyon Rd

Name: 7020 UnityPoint Health Trinity Regional Medical Ctr

Name: Case Management

FLSA Status: Non-Exempt

External Company URL: http://www.unitypoint.org

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