Employment Type:

Shift:

Description:

The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the utilization review process and patient progression from Admission to Discharge. Through partnership and collaboration with all members of the healthcare team, the UR/CCM is the principal liaison between emergency services, surgical services, nursing, finance, physicians, and medical records. In addition, they are responsible to coordinate safe and appropriate discharge plan for the patients within their service area.

Organization Highlights:

• Recognized Leader: First Magnet Designated Hospital in Syracuse, highlighting our professional nursing staff.
• Excellence in Clinical Outcomes: Only hospital to receive a Leapfrog safety grade of A.
• Shared Governance: Unit practice counsel and open-door guiding principle gives all our nurses a voice.
• Professional Relationships: Strong rapport with the physician groups and clinical affiliates.
• Advancement: Strong orientation program and generous tuition allowance.
• Work/Life: Self-scheduling options to balance your work/life and school calendars.

What you will do:

• Completes initial and follow up case reviews on all patients as dictated by payer and status.
• Uses Interqual and Indicia/MCG software and Physician Advisors to determine appropriate patient status/level of care.
• Follows Medicare guidelines and industry standards to ensure the proper patient class is assigned.
• Acts as a liaison with the Hub to facilitate appropriate patient placement, level of care and patient progression at a unit level to achieve system efficiency.

• Leads daily SNAP huddles and works collaboratively with unit staff and support team (RN, Physician/Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to progress each patient's care towards discharge.

• Serves as a consultant and educator with medical staff regarding status, placement, payer requirements, and utilization of resources.
• Performs Initial Stay reviews.
• Reviews LOS values and working DRG daily; Updates in Care Logistics software as needed.
• Identifies opportunities to transition testing to the outpatient setting and escalates as appropriate
• Identifies/assesses patient for readmission risk, communicates to care team, and updates Care Logistics software.

Responsibilities:

• Ensures quality nursing care is rendered to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing and Clinical Service standards of care and practice.
• Maintains current knowledge of basic health care economics, trends and reimbursements methodologies and applies knowledge to daily practice. Recognizes situations that require immediate intervention. Continues to develop professionally and apply knowledge and skills necessary to provide care appropriate to each patient.
• Utilizing the Nursing Process, plans, directs and supervises the care of patients in addition to being involved in preparing the discharge plan for patients and families.

Education, Training, Experience, Certification and Licensure:

• Licensed Professional Registered Nurse with a minimum of 2 years clinical experience in a hospital setting. Bachelor’s degree in appropriate discipline with one to two years progressive experience in the field is acceptable.
• Current BLS/CPR certification.
• Discharge planning, home care, and/or managed care experience desired.
• Participates in orientation, education conference, updates and maintains knowledge and skills related to specific areas of practice.

Career Path:

• Clinical ladder advancement with experience, staff engagement, and national certification.
• Career advancement to leadership roles as preceptor, mentor, coordinator/management.

Special Equipment, Skills or Other Requirements:

• Organizational, management and leadership skills.
• Proficient Oral and written communication skills.
• Demonstrated ability for problem solving and conflict management.

Work Environment and Hazards:

• OSHA category I. Routine or potential exposure to blood, body fluids, excretion or secretions.

Physical Demands:

• Moderate work: lifting, bending, stooping, pushing and pulling. Heavy work: standing and walking.

Work Contact Group:

• All services medical staff, patients, visitors, contractors, vendors, and various regulatory and professional agencies.

Supervised By: Manager and Director

Supervises: None

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.