Utilization Manager

Distinctive Home & Health Care is a leading provider of healthcare to serve military installations across the United States. Our team of professionals is dedicated to providing the highest quality of service and support for each one of our clients. Distinctive Healthcare is currently seeking to hire a full time Utilization Manager at the Hickman AFB in Oahu, Hawaii.

Minimum Qualifications:

• ? Degree: Associates Degree of Nursing.
• ? Education: Graduate from a college or university accredited by National League for Nursing Accrediting Commission (NLNAC), or The Commission on Collegiate Nursing Education (CCNE).
• ? Certification: Possess one of the following certifications: o Commission for Case Manager Certification Certified Case Manager (CCM) o Certification of Disability Management Specialists Commission: Certified Disability Management Specialist (CDMS) HT005018D0029 (emendez18630) Page 52 of 141 o Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) o American Board for Occupational Health Nurses Certified Occupational Health Nurse (COHN) or Certified Occupational Health Nurse-Specialist (COHN-S). o National Board for Certification in Continuity of Care: Advanced Certification in Continuity of Care (ACCC) o Commission on Rehabilitation Counselor Certification: Certified Rehabilitation Counselor (CRC) o American Nurses Credentialing Center Nurse Case Manager (RN-NCM) o National Academy of Certified Care Managers: Care Manager Certified (CMC)
• ? Experience: One year of experience in nursing as identified in the TO after graduation.
• ? Licensure: Current, full, active, and unrestricted license to practice as a Registered Nurse as required in the TO.

Core Duties:

• ? Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.
• ? Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring. Identify opportunities for CM and identify and integrate local CM processes.
• ? Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM
• ? Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.
• ? Integrate CM and utilization management (UM) and integrating nursing case management with social work case management.
• ? Maintain liaison with appropriate community agencies and organizations.
• ? Accurately collect and document patient care data.
• ? Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness.
• ? Establish mechanisms to ensure proper implementation of patient treatment plan and follow-up post discharge in ambulatory and community health care settings.
• ? Provide appropriate health care instruction to patient and/or caregivers based on identified learning needs.