Utilization Management Nurse

Are you passionate about spending quality time with seniors and providing the care they deserve?
Are you interested in joining a team that truly cares about its employees and values their voice?
Do you aspire for career growth and development opportunities?
If your answer is a resounding "yes" to these questions, we would love to hear from you.
The One Senior Care family of businesses, including LIFE-NWPA and Cherry Blossom PACE, work as a team to help seniors stay safe, healthy, and independent in their homes and communities. We are a premier healthcare provider striving to provide excellent patient care beyond the traditional boundaries of medical insurance plans!
Benefits:

• 9 Paid Holidays
• 3 Weeks and 1 Day of Paid Time Off Accrued from the Date of Hire for Full-Time Employees
• Annual Pay increases for Performance
• Medical, Dental, & Vision
• Free Life and AD&D Insurance Plan
• Health Savings and Flexible Spending Accounts
• Short Term Disability Insurance
• Group Voluntary Term Life Insurance for Employee, Spouses, and Dependents
• Paid Parental Leave
• Tuition Reimbursement
• Retirement Plan with Up to 5K Matching Annually / Vesting Schedule (Pre-taxable Savings)

Salary: Starting at $79,040 / yr.
Schedule:
8:00 am - 5:00 pm; Monday-Friday. Please note work hours may fluctuate depending on the Participant and business needs, flexibility is required.
Job Summary:
The Utilization Management Nurse role is to ensure health care services provided to participants are monitored and administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing participant treatment files, the Utilization Management Nurse will ensure that participants receive necessary procedures, effective treatment through collaboration with external hospital and skilled nursing facilities teams reducing the opportunity for readmission. The Utilization Management Nurse oversees the care of a participant as they move from one health care facility, such as a hospital or nursing home, to another facility or their home. By continuously collaborating with internal and external departments, ensuring the relocation is as smooth as possible and helps the participant remain comfortable during the change.
Duties/Responsibilities:

• Managesdaily participant utilization flow:
  • Identifies recommended level of care and services.
  • Provides information that assists with decision making related to participant care management and discharge planning, pre-emptively working with care teams to prevent hospitalization / readmission when possible and appropriate.
• Performs/Establishes Dailywith Clinic Nurse Managers or designee on participants progress and discharge needs.
• Communicates and guides ER staff regarding Participant's care needs.
• Coordinates participant's discharge planning needs with internal and external healthcare teams
• Structures hand-off processes from acute facility to post discharge location team.
• Evaluates care/services provided during acute [hospital] and SNF stay,Identifies and communicatesvariances from the clinical path and deviations from physician's orders to appropriate staff/physicians, as well as identifies delays in treatment services to research root causes and improvement opportunities.
• Concurrent reviews of those participants in ER/Acute [hospital]/SNF settings clinical information and chart reviews for all acute and short term SNF stays.
• Completes full retrospective chart review of at least 80% of ER, inpatient and Short Term SNF stays.
• Provides chart review data to the QI committee and Clinical Leadership inclusive of but not limited to the Medical Directors and Director of Clinical Operations.
• Develops and sustain relationships with external partners (acute settings, Emergency Medical Service, SNF)
• Develops relationships with participants, family, and caregivers.
• Attends meetings as appropriate.

Education and Experience:

• Must be a graduate of an accredited nursing school and have a current Pennsylvania RN license.
• Minimum of two years of experience in Utilization Management
• One year of experience working with the frail and elderly population or willing to participate in extensive training as needed.

Required Skills/Abilities:

• Relates well with people of all ages and has a deep sensitivity and commitment to the elderly.
• Ability to organize work and follow through on assigned tasks.
• Strong verbal communication skills and can follow written and/or follow oral direction.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must be able to deal tactfully and patiently with personnel, Participants, family members, visitors, government agencies/personnel, and the public.
• Interact well with others in any situation.
• Must have the cognitive ability to process and perform tasks for Participant safety.
• Work in an intensive, fast-paced environment with minimal supervision.
• Demonstrate critical thinking skills.
• Demonstrated adaptability to changes in health care environment with proactive problem-solving attitudes.
• CPR and First Aid Certification. (Training Provided)

Prescreening Requirements:

• Successful completion of background check, physical, drug screening, TB Screening

Physical Requirements:

• Must be able to move intermittently throughout the workday.
• Must be able to lift, push, pull, and move a minimum of 25 pounds.
• Must be able to assist with the evacuation of Participants.

Our organizations provide equal employment opportunities to all employees and applicants for employment. It prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
The OSC family of businesses will only hire qualified individuals to work in a federally funded healthcare program. Please note that this excludes anyone convicted of a crime that could jeopardize the safety and well-being of the frail senior population that OSC/LIFE-NWPA/CBP serves. All individuals must disclose any conflicts of interest upon applying for a position and agree to a thorough background check when an employment offer is extended.
Employment Requirements: Successful completion of Pennsylvania Criminal History Check, PA DHS Child Abuse Clearance, Office of Inspector General check, and FBI Fingerprinting for Child Protective Services Law (at employer's expense). Successful completion of post-offer employment drug screening and physical (at employer's expense). CPR and First Aid Certification, or willing to obtain at employer's expense. Individuals must have one year of prior experience caring for the frail elderly or willing to complete Company paid training to meet this requirement.
This position has full access to Participant, program, and staff records and reports, requiring discretion to protect individuals and the program.