Reports to the Manager/Utilization Review and Case Management. Is responsible for assessing, planning, coordinating and evaluating orientation, continuing education and in-service programs for staff which are competency based. Recommends improvements in the quality of utilization review practice and standards. Serves as a resource to staff. Assists with steps to resolve preventable denials and coordinates with the Manager to identify and correct weaknesses in the revenue cycle process that can mitigate future denials.MISSION, VALUES and SERVICE GOALS
MISSION: We deliver outstanding care, inspire health, and connect with heart.
VALUES: Trust. Respect. Integrity. Compassion.
SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
Orientation of New Hires
Develops curriculum and keeps current new hire orientation for all positions affecting UR at both hospitals and any other positions associated with UR Departments.
Develops schedules, teaching methods, evaluation tools, preceptor development programs, and coordinates for all parties a smooth onboarding and training process.
Works with manager to assure performance progress is documented and feedback whether positive or corrective for timely movement through orientation phase.
Continuing Education and Competency Validation
Assess learning needs of UR associates and develops plan, goals, and validates with management and associates.
Assures competency assessment of staff working in UR Process through audits, direct observations/discussions, and individual education plans as needed.
Responsible for all staff development activities around upgrades to UR tools, criteria sets, and other mechanisms/processes needed in UR process.
Assists as a resource regarding UR situations of concern and decision making.
Keeps records of all education and competency validation activities.
Project Management
Leads or participates in strategic initiatives in the revenue cycle where utilization review plays a role and communicates relevant information to other departments
Supports management communications and actions to assure effective change management culture in departments.
Performance/Process Improvement/Efficiency
Evaluates work processes, identifies inefficiencies, lack of standardization, and opportunities for improvement.
Collects information through data collection, observations, surveys, interviews, etc., to analyze the process.
Develops metrics for success and collaborative approach to design improvement.
Implements PDCA and LEAN tools as indicated to refine, measure, revise, and sustain improved processes in UR.
Monitors select measures for oversight committees and prepares timely reports.
ORGANIZATIONAL RESPONSIBILITIESAssociate complies with the following organizational requirements:
Attends and participates in department meetings and is accountable for all information shared.
Completes mandatory education, annual competencies and department specific education within established timeframes.
Completes annual employee health requirements within established timeframes.
Maintains license/certification, registration in good standing throughout fiscal year.
Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
Adheres to regulatory agency requirements, survey process and compliance.
Complies with established organization and department policies.
Available to work overtime in addition to working additional or other shifts and schedules when required.
Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:
Leverage innovation everywhere.
Cultivate human talent.
Embrace performance improvement.
Build greatness through accountability.
Use information to improve and advance.
Communicate clearly and continuously.
Education and Experience
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor of Science in Nursing degree and current license to practice as a Registered Nurse in Indiana. A Master's degree in Nursing or advanced degree is preferred. Two years of recent utilization review/case management experience is required.
Knowledge & Skills
Demonstrates comprehensive knowledge of current training and adult education philosophies, techniques, programs, tools and equipment.
Demonstrates comprehensive knowledge of and competency in performing utilization review/case management functions.
Demonstrates critical thinking and analytical skills necessary to conduct training needs analysis, design programs, identify variances in standards of care.
Demonstrates ability to teach staff with a variety of educational backgrounds.
Demonstrates leadership skills necessary to coordinate activities and motivate all levels of staff.
Demonstrates initiative and high interest in teaching others.
Demonstrates well-developed interpersonal skills necessary to interface effectively with all levels of staff and customers and to conduct group and individual instruction.
Demonstrates well-developed communication skills, both verbal and written, necessary to communicate in an articulate and effective manner in front of groups. Relates to and provides effective feedback to the learner in a manner that is patient, constructive and enhances self-esteem.
Requires fundamental knowledge of the revenue cycle process, which includes such things as patient access, utilization review, charge capture, HIM and patient accounting.
Working Conditions
Works in a fast-paced environment requiring frequent changes in job demands.
May be exposed to bio-hazards.
Skillful in use of information technology including Excel, PowerPoint, Word and software tools.
Physical Demands
Requires the physical ability and stamina to perform the essential functions of the position.
