RN Supervisor, Utilization Management

Summa Health System is recognized as one of the region’s top employers by a number of third party organizations, including NorthCoast 99. Exceptional candidates gravitate to Summa because of its culture, passion for delivering excellent service to our patients and families commitment to our philosophy of servant leadership, collegial working relationships at every level of the organization and competitive pay and benefits.

Summary:
Provides development and oversight of utilization management. Serves in a leadership role in developing interfaces with clinical staff across the continuum directly supervising Utilization Management RNs ensuring competency, productivity, and efficiency. Works directly with the Manager, Transitional Care & Utilization Management to collaboratively achieve quality care outcomes for all patients as they transition from one setting to another. Manages appropriate cost-effective utilization of services across the care continuum to align with improved clinical outcomes and lower costs. Demonstrates responsiveness to changing health care needs of the patient population and changes in insurance contracts and payment modalities such as bundled payments and shared risk arrangements. Collaborates with Case Management, Physician Advisors, Providers, Revenue Cycle, and department leadership to effectively manage patient status in the acute hospital setting per CMS and payer guidelines through application of clinical criteria sets (MCG/InterQual) and compliance to CMS guidelines.Provides development and oversight of utilization management. Serves in a leadership role in developing interfaces with clinical staff across the continuum directly supervising Utilization Management RNs ensuring competency, productivity, and efficiency. Works directly with the Manager, Transitional Care & Utilization Management to collaboratively achieve quality care outcomes for all patients as they transition from one setting to another. Manages appropriate cost-effective utilization of services across the care continuum to align with improved clinical outcomes and lower costs. Demonstrates responsiveness to changing health care needs of the patient population and changes in insurance contracts and payment modalities such as bundled payments and shared risk arrangements. Collaborates with Case Management, Physician Advisors, Providers, Revenue Cycle, and department leadership to effectively manage patient status in the acute hospital setting per CMS and payer guidelines through application of clinical criteria sets (MCG/InterQual) and compliance to CMS guidelines.

1. Formal Education Required:
a. Associate’s degree in Nursing (ADN) required, BSN preferred
b. Graduate of a program of professional nursing that is accredited by the Commission on Collegiate Nursing Education (CCNE) or Accreditation Commission for Education in Nursing (ACEN)
c. Current license to practice registered nursing in the State of Ohio

2. Experience and Training Required:
a. Three (3) years recent experience in utilization management, discharge planning, managed care, and/or case/care management.

3. Other Skills, Competencies and Qualifications:
a. Ability to make decisions based on independent judgment, appropriate analysis/response to issues involving patient care, program management and personnel supervision.
b. Ability to work effectively in a high-power environment.
c. Ability to direct multiple entities functions which have a significant impact on the organizations processes.
d. Understanding of utilization management processes and principles.
e. Demonstrated ability to communicate clearly and effectively orally and in writing.
f. Ability to analyze and use clinical outcome and aggregate data.
g. Clinical knowledge of patient population needs including high risk patients and patients with chronic illness.
h. Ability to work independently and to prioritize work and solve problems.
i. Demonstrated expertise in utilization management.
j. Ability to lead and facilitate interdisciplinary care processes and across multiple settings.
k. Demonstrates knowledge of utilization management processes and incorporates regulations into a care planning process for patients and families.
l. Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

4. Level of Physical Demands:
a. Sedentary: Exerts up to ten pounds of force occasionally and/or a negligible amount of force frequently.