RN Medical Utilization Management Educator

Registered Nurse

Looking For Utilization Management AND Education Experience.

Scope of work:

In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral Health, Care Management, and Utilization Management departments. Stakeholders include staff, physicians, department leadership, and third-party vendors. Uses specific age and culture-related physical, intellectual, psychological, and development attributes in the educational plans for staff. Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with matrix reporting to other areas in Medical Management.

• Develops/implements the educational plan for Behavioral Health, Care Management, and Utilization Management.
• Develops/implements orientation of new staff which is comprehensive and individualized with one-on-one training for three or more weeks.
• Rounding and telephonic support of staff education needs and problem solving.
• Ongoing education based on analysis of outcomes from external audits.
• Education and support for implementation and ongoing use of new electronic medical record system and supplemental ancillary computer systems.
• Collaborate with educators to Provide education and support as needed.
• Conducts department-specific assessment for educational needs related to Compliance Monitoring and Education.
• Monthly auditing of Compliance Risk areas and identification of staff education and documentation needs to ensure compliance
• Annual education on InterQual ® criteria changes with annual Interrater Reliability Assessment.
• Analyze and evaluate the effectiveness of all educational activities.
• Conducts educational workshops to medical management and related audiences as requested.
• Education of changes and payor requirements to targeted Physician groups.
• Develops informational materials and/or other media to be distributed to internal/external customers.
• Internal/external orientation material.
• Maintains and updates repositories of educational content needed for staff orientation, day-to-day operations, and continuing education on Sharepoint sites.
• Develops annual education plan to ensure Care and Utilization management staff have access to current best practice and relevant updates.
• Monthly auditing for specific areas of focus as directed by leadership, to ensure adherence to clinical best practice.

• Department Liaison for external audits.
• Coordinates and facilitates with other departments to ensure readiness for audits
• Analyze audit recommendations
• Reporting outcomes and development/implementation of staff education as needed.
• Assists with project and program improvement efforts
  
  

Qualifications

• Required Bachelor's Degree
• Preferred Master's Degree
• Utilization Management experience highly preferred.
• Education and/or training experience highly preferred
• 3 years of relevant experience Must have 3 to 5 years' experience in Care Management, or Utilization Management. Required
• Registered Nurse (RN) - State of Michigan Upon Hire required
  
  

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status
  
  

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Utilization Management Operations - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.