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Utilization Management Coordinator

Location: Pittsburgh

Department: Nursing (LPN/RN/CRNP)

Schedule: Mon-Fri 7:30am-4:00pm

Summary of Job Duties:

The Utilization Management Coordinator (UMC) is responsible to perform /coordinate utilization management functions across all levels of care (LOC).  The UMC supports the established hospital & nursing facility service authorization process by adhering to the utilization management protocols and guidelines.  In compliance with Community LIFE policies, industry standards, medical criteria and necessity, the UMC recommends and coordinates clinically sound and consistent level of care coverage decisions to assure the delivery of the “right care at the right time in the right location.”  The UMC interprets clinical information provided or reviewed and works closely with RN Case Managers (RNCM) to ensure the Participant goals of care are known to the health care providers across the continuum and at each transition of care. The individual who qualifies for this position must demonstrates strong verbal and written communications skills, the knowledge and skills necessary to assess, plan care for and provide services to frail elders. 

Required Education:

Bachelor’s degree in nursing preferred or an equivalent for a bachelor’s degree. An equivalent substitution is a minimum of 4 years of demonstrated successful experience as an effective team member caring for geriatric patients.  Graduate of an accredited Registered Nursing program.

Required Licensure:

License and current registration to practice as Registered Professional Nurse in the state of Pennsylvania.  Valid PA Driver’s License.

Required Experience:

Three to five years’ experience in a health facility, community based setting and/or a managed care environment, preferably dealing with long term care clients and/or the frail elderly.  One to three years’ experience in utilization or case management in an insurance company, hospital or long-term care facility.  Experience in data management and presenting data in a meaningful way needed. 

Required Skills:

 

  • Ability to interpret clinical information to support utilization protocols for authorizing inpatient services.

  • Team formation and facilitation skills and ability to work with multiple disciplines. 

  • Demonstrable ability to communicate effectively verbally and in writing.

  • Personal computer skills including Outlook, Word, PowerPoint and Excel. 

  • Self-organization skills; attentiveness to detail and accuracy. 

  • Excellent assessment skills.

  • Knowledge of current acute and long-term care utilization standards. 

  • Ability to plan and coordinate care for individuals, families and groups. 

  • Ability to establish and maintain cooperative working relationships. 

  • Ability to accept and utilize guidance. 

  • Acceptable physical and mental health to carry out the responsibilities of the position.

  • Ability to compile and report data in a meaningful way.

 


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