RN -Utilization Review Supervisor

Company: Providence
Location: Olympia
Posted on: February 5, 2025

Job Description:

Description The Supervisor for Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Washington - NW Region. This role assists in the care of the patient through assessment, planning, implementation, and evaluation of appropriate services and resources to maximize optimum outcomes. The UM Supervisor assists the Washington NWR Director of Care Management in support of programs by providing ongoing assessment and evaluation of hospital activities. MAJOR CHALLENGES:

• Developing interpersonal communication skills among team members as UM/CM processes develop, which promotes trust, learning, recognizing and building on individual strengths.
• Maintaining knowledge and skill base in a rapidly changing and pluralistic medical, healthcare, and reimbursement environment.
• Integrating and coordinating the work processes and information across the continuum of care. The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position. The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending upon the nature of the position. Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization. For direct patient care roles: Performs and maintains currency of essential competencies as required by specific area of hire and populations served. Applies concepts of the nursing process, such as identification of disease, facilitation of healing, health promotion, illness prevention and patient care delivery to each task, clinical review and or quality improvement project. Responsible for success of Utilization Management Program in the Washington NW Region. Demonstrated ability to evaluate patient status, continued stay and other utilization management activities utilizing severity of illness and intensity of services criterion. Demonstrated understanding of compliance and regulatory requirements from Center for Medicare and Medicaid Services, The Joint Commission, state and Washington Patient Safety Commissions. Knowledge of reimbursement requirements and strategies. Knowledge of denial process and denial appeal management. Responsible for the hiring, performance management, and annual evaluations for UM caregivers. Participates in the development and maintenance of processes to assure continuity and consistency of services. Responsible for keeping caregivers current and informed of changes to standards, policies, procedures, etc. Demonstrates understanding and utilization of tools, tones and behaviors that promote patient safety in a highly reliable organization. Leads and coordinates assignments of duties to include performance improvement activities in Utilization Management. Required Qualifications:
  • Upon hire: Washington Registered Nurse License
  • Previous healthcare administration and/or delivery of healthcare services
  • Utilization Management/Review Preferred Qualifications:
    • Bachelor's Degree in Nursing Baccalaureate degree (BSN) from an accredited school of nursing. Applicants without a BSN degree must actively pursue and attain a BSN within five years of hire
    • 2 years in acute care or quality improvement
    • Progressively responsible experience supervising people
    • Experience related to a wide variety of patient populations and care delivery models Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. About the Team Providence has been serving the Pacific Northwest since 1856 when Mother Joseph and four other Sisters of Providence arrived in Vancouver, Washington Territory. Today, Providence is the largest health care provider in Washington located in communities large and small across the state. In western Washington, Providence provides care throughout the greater Puget Sound from Snohomish County to Lewis County. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 340679 Company: Providence Jobs Job Category: Clinical Quality Job Function: Quality/Process Improvements Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 3002 UTIL REVIEW WA PRMCE B1 COLBY Address: WA Everett 916 Pacific Ave Work Location: Everett Medical Ctr Pacific-Everett Workplace Type: On-site Pay Range: $59.39 - $93.75 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.PandoLogic. Category:Quality Control, Keywords:Quality Control / Quality Assurance Supervisor, Location:Olympia, WA-98507

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