Utilization Management Registered Nurse (RN)

Utilization Management RN
CINQ Connect NY LLC
Position Description
Overview
The UM RN reports to the Director of Clinical Operations or designee, CINQ Care Inc., with accountability for effectively extending our care team approach by collaborating with hospitals, skilled nursing, and rehabilitation facilities to address inpatient care, discharge plans, and coordinate post discharge follow up on medical, social, and behavioral health needs via the phone and/or facility on-site visits. The UM RN should embody CINQ’s core values, including Imagination, Partnership, Forthrightness, Humility, Courage, and Relentlessness.
Primary Responsibilities
The UM RN will have the following responsibilities:

• Daily, Weekly review of hospital/SNF individual patient medical records determining reason for admission, review of medical history, anticipating length of stay and discharge needs.
• Review and analyze the patient’s treatment plan and ensure that it is both effective, cost-efficient, and aligned with evidence-based medicine guidelines
• Provide continuous review concurrently during the hospitalization and post discharge review by attaining the discharge summary to establish a personalized treatment plan.
• Interface with patients, physicians, hospital discharge planners regarding the status of patient and recommend services that support discharge care.
• Assist in discharge planning, helping patients transition from inpatient to at-home care
• Coordinate patient care by directing to the most appropriate specialist or ancillary provider
• Participate in Daily Hospital Census Rounds forum to discuss the patient’s inpatient status, anticipated discharge and create a post discharge care plan in conjunction with the PHN, Nurse Case Manager and PCP, leveraging others in the Care Team as required
• Work with our medical providers, consulting the primary care provider for input, and refer the patient to that provider in real time whenever appropriate
• Offer patient education when appropriate
• Other duties as assigned

General Duties
The UM RN shall have following duties:

• Leadership: The UM RN will lead the rounds sessions and offer solutions to deliver desired clinical and operational outcomes.
  

• Collaboration: The UM RN will work closely with other clinical departments to learn their needs, internalize their knowledge, to achieve the clinical objectives of CINQ Care Inc.

• Knowledge: The UM RN will provide clinical solutions and use the subject matter expertise of the Care Team to reduce hospital lengths of stay and assist with care coordination as patients return to the community.

• Culture: The UN RN is accountable for creating a productive, collaborative, safe and inclusive work environment as part of the larger Company.

Qualifications
The UM RN should have the following qualification:

• Education: Active, unencumbered NY State License, Bachelor’s or equivalent degree in Nursing, Certification in Case Management preferred

• Experience. Experience with utilization review either in the hospital or with a managed care company, at least one year of experience in a medical office preferred, Experience working with Excel, Word and EMR, Medent (preferred)

• Entrepreneurial. CINQ seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise

• Communication. Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQ’s team, investors, partners, and other stakeholders. Proficiency in all Microsoft Office applications

• Relationships. Ability to build and effectively manage relationships with clinical and business leaders and external constituents

• Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.

Location: Buffalo, NY
Compensation: $71,000 - $81,000 annually

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