Under the general supervision of the Director, nurses in the Utilization Management Coordinator role provide clinically-based case management to support the delivery of effective and efficient patient care. Has overall accountability for the utilization management. Collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement.Reviews appropriateness of testing and procedures and makes recommendations based on assessment findings. Participates in hospital initiatives and projects as identified.

RESPONSIBILITIES:

• Assesses for the appropriateness of diagnostic testing, procedures, and consults.Discusses alternative options with providers if not medically appropriate at inpatient or observation level of care.
• Acts as a liaison to bed control to assist with patient throughput.
• Daily review and reporting on patients in observation level of care. Utilizes clinical guidelines as appropriate to assist with level of care determination. Follow up with providers when discrepancy in level of care is found.
• Assesses and tracks transfer DRG's and provides up to date and accurate reports of interventions and findings.
• Analyzes peer to peer data and provides feedback to the leadership team.
• Superuser/content expert for Allscripts.
• Collaborates with physicians and interdisciplinary team members to utilize appropriate testing during hospitalization.Assists with coordinating and scheduling outpatient testing as appropriate.
• Uses clinical knowledge and knowledge of anticipated response to treatment to assess patient progression towards anticipated outcomes. Communicates and coordinates with the health care team to intervene when progression is stalled or diverted.
• Completes the interventions necessary for discharges to home with self-care, home with services and short term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for placement prior to the day of discharge.
• Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
• Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge.
• Provides support for new projects and hospital initiatives.
• Develops training guides and metric tools for the case management team.Orients new team members and acts as a point of contact and support for the department.
• Acts as team lead support in the absence of the director including attending huddles and meetings as needed.
• Perform other related duties as required

REQUIREMENTS:

• Licensed as a Registered Nurse in the State of Connecticut.
• Graduate nursing program (Diploma/Associates) BSN preferred or actively working towards BSN.
• Case Management certification preferred.
• Minimum of 5 years of broad clinical experience, predominately in medical/surgical nursing.
• Case Management, discharge planning and utilization review experience preferred.
• Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.
• Communicate in a clear, concise, and logical manner in oral and written presentations.
• Strong interpersonal, communication, and negotiation skills.
• Ability to form positive, collaborative relationships with hospital staff, patients and families.
• Ability to effectively negotiate with internal and external providers of patient care services.
• Analytical abilities to assist in obtaining solutions to problems.
• Able to work independently and prioritize work.
• Able to manage multiple priorities.
• Basic knowledge of computers and clinical applications.
• Basic knowledge of Microsoft Office, including Excel and PowerPoint
• Must complete all Waterbury Hospital mandated trainings, safety and compliance assignments