Job Description

Job Title: Utilization Management RN Reviewer - Hospice (Altoona)
Job ID: 95154237
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Family Hospice & Palliative Care OP
Department: HSP Education Quality
Location: 20 Sheraton Drive, Altoona PA 16603

Description

Are you an experienced nurse looking to join one of the fastest growing branches of the healthcare industry? Are you interested in a unique nursing position that allows for a more work within an office setting? This is the role for you! As the Utilization Management RN Reviewer with Family Hospice, you will provide direction and guidance to admission and clinical staff related to the overall functions of the Utilization Management department including but not limited to accurate, complete and compliant documentation.

Responsibilities:

  • Identify, investigate and recommend solutions to organization issues
  • Collaborate with clinical management to assist in identification and resolution of staff performance improvement areas and monitor and report upon progress
  • Meet the regulatory, contractual and fiscal month end time frames for documentation submission and month end billing close. Serves as a role model of professional nursing practice by serving as a recognized unit leader in one or more of the following areas: clinical expertise, teacher, specialized resource nurse, and/or evidence based practice.
  • Consistently gives appropriate feedback to all members of the health care team and participates in the nursing peer review process.
  • Promotes change that enhances the quality of patient care and the unit environment.
  • Serves on teams and leads successful teams as a part of daily practice.
  • Identify, develop and participate in process improvement opportunities within the home health agency that will enhance the quality of the serviced provided. Identifies opportunities for clinical quality as well as workplace improvement. 
  •  Applies evidence based practice as a regular aspect of professional practice.
  • Serves on or leads teams that launch innovations in patient care or support a healthy workforce.
  • Critically evaluate and provide direction and education related to utilization of services, diagnosis and teaching sheet selections on all comprehensive assessments. Review OASIS and 485 Plan of Care for accuracy and completeness and ensure correct coding assignment
  • Perform duties and job responsibilities in a fashion which coincides with the service management philosophy of UPMC/Jefferson Regional Home Health, L.P. toward patients, visitors, staff, peers, physicians and other departments within the organization. Focus on customer service and continually strive to perform the duties of job in a manner that results in optimal patient satisfaction.
  • Builds and mends relationships among colleagues within the framework of a healthy workplace.
  • Role models keen cultural awareness including preventing and addressing horizontal violence and impairment.
  • Maintains a conscious balance between work and personal life through prioritization and delegation of responsibilities.
  • Demonstrate knowledge of most recent COP's, PPS regulations and Joint Commission standards and ensure department compliance.Attend compliance training and adhere to the organization standards of conduct, policies and procedures. 
  • Serve on agency committees Demonstrates a passion for developing others, enthusiastically and expertly precepts students, graduate nurses and new hires.
  • Analyzes clinical and behavioral situations, identifying learning opportunities to improve patient care practices.
  • Regularly seeks feedback on performance and applies continuous professional improvement.
  • Supports continuous learning in the clinical area by sharing research, materials from professional organizations, presenting on the unit, supporting journal clubs, etc.

 

Qualifications

  • Graduate of accredited school of professional nursing required
  • BSN preferred. 2 years experience in home health required.
  • 2 years utilization review experience preferred.
  • Demonstrated proficiency in Medicare, Medicaid and commercial insurance regulations and in JCAHO standards required.
  • Knowledge of ICD 10 coding required.

    Licensure, Certifications, and Clearances:
  • Automotive Insurance
  • Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
  • Driver's License
  • Registered Nurse (RN)
  • Act 33
  • Act 34
  • OAPSA

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $20.79 to $35.99 / hour

    Union Position: No

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    UPMC VALUES

    At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

    QUALITY & SAFETY
    DIGNITY & RESPECT
    CARING & LISTENING
    RESPONSIBILITY & INTEGRITY
    EXCELLENCE & INNOVATION

    UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


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