Nurse Clinician - Level Of Care/Utilization Management - 100%

The University of Iowa Hospitals & Clinics within the Continuum of Care Division, Level of Care (LOC), Utilization Management (UM) Team is looking for a Nurse Clinician to functions as a clinical nurse expert and clinical coordinator acting as nurse liaison to physicians, patients and administration. Candidate will clinically review and facilitate changes in level of care, based on systematic evaluation, utilization management and evidence-based research. Incorporating Milliman care Guidelines in each review. This position will strive to achieve quantitative measures of success across the UIHC Hospitals, including Stead Family Hospital and University of Iowa Healthcare.

Position Responsibilities

• Remains calm and constructive in conflict situations, listens and attempts to understand other points of view.
• Performs other special projects and tasks as assigned.
• Collaborate with health care professionals (managers, administrators, schedulers, internal and external providers, and other care coordinators) to facilitate smooth transitions of care.
• Autonomously communicates with referring physician
• Listens to feedback without defensiveness and uses it to enhance communication effectiveness.
• Provide clinical information to relevant clinical team members regarding patient needs and/or newly identified issues, specifically working with the Utilization Management team.
• Exhibits good teamwork is approachable, cooperative, and contributes to an overall positive and productive work/team environment.
• Analyze initial and ongoing assessment data to determine diagnoses and determine appropriate level of care.
• Develops & presents educational materials to inpatient units approved by the Nurse Manager.
• Maintains confidentiality of patient and staff information.
• Develop educational resources (verbal and printed) based on evidence-based practices to ensure improved patient and family understanding.
• Responsible for maintaining clinical expertise consistent with patient population requirements and current nursing and medical practice.
• Serves as an educational and clinical resource to clinics, patients, families, staff, and the community.
• Conducts quality improvement initiatives within the care setting under the direction of the Nurse Manager.
• Collaborates in the implementation of patient care plans and follow-up care coordination for patients within the primary care clinics.
• Uses judgment and expertise to apply and adopt information within total clinical picture to address patient health issues.
• Provide education regarding primary care information not only at a clinical level, but at times an institutional and/or community level approved by the Director of Population Health | ACO Operations and Population Health Medical Director.
• Seek opportunities to enhance one's own knowledge, skills, and abilities within the clinical coordinator role, recognizing its contribution to the mission and goals of the institution.
• Demonstrates the core values of service leadership: respect, communication, accountability, integrity, and compassion.
• Serve as clinical resource to social services and other providers/care coordinators, specifically regarding the compliance portion of the level of care.
• Conduct chart reviews to evaluate care practices and deficiencies. Per chart review, prepares and presents educational program for nursing staff at that level of care.
• Participate in the development and implementation of disease-specific management programs with associated educational and clinical resources to support the patient/family/staff.
• Maintain an understanding of third-party coverage with respect to Medicare, Commercial and Medicaid policies and procedures.
• Seeks opportunities to enhance one’s own professional knowledge, skills, and abilities as they relate to one’s current position and/or to prepare for potential future roles and overall career development.
• Use relevant nursing research to improve clinical practice and investigate nursing care problems as evidence by reviewing updates in the Milliman Care Guidelines.
• Represents the interests of the University and of unit leadership in the use of resources to meet service and productivity demands within unit goals and budgets; strives to promote continual process and quality improvement.
• Adheres to professional and legal standards of nursing practice.
• Works effectively with individuals from all backgrounds.
• Communicates in alternative ways to accommodate different listeners.
• Facilitate patient-centered clinical assessment and care coordination throughout the healthcare continuum, working with multiple members of the health care team, from the Emergency Room, Nurse Navigators as well as Providers.
• Coordinate and facilitate patient care between multiple disciplines including home health agencies, referring physicians and other community support services. Facilitates continuity of care.
• Maintains effective working relationships with faculty, staff, students, and the public.
• Welcomes the richness of talent from a diverse workforce and recognizes that diversity brings stimulation, challenge, and energy that contribute to a productive and effective workplace.
• Demonstrates respect for all members of the University community in the course of performing one’s duties and in response to administrators, supervisors, coworkers, and customers.
• Communicate with physicians and members of the health care team directing patient care.
• Collaborates with nursing staff and other health care professionals in the development and review of standards and apply these standards when planning, implementing, and evaluating patient care for the primary care population.

Percent of Time: 100%

Schedule: Monday – Friday, shifts primarily between 7:00 am and 6:00 pm. Occasional weekends.

Pay Grade: https://hr.uiowa.edu/pay/pay-plans/seiu-pay-plan

Benefits Highlights

• Regular salaried position located in Iowa City, Iowa
• For more information about Why Iowa?, click here
• Fringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plans

Required Qualifications

• Demonstrated experience coordinating care along the healthcare continuum
• Excellent written and verbal communication skills
• Experience working in an interdisciplinary team.
• 1-3 years of recent clinical health care experience including care coordination
• Demonstrated excellence in critical thinking, organizational skills, independent decision-making, time management, prioritization, and problem-solving skills
• Current license to practice nursing in Iowa is required by date of hire.
• Proficiency in computer applications including Microsoft Excel, Word, and PowerPoint
• A Baccalaureate degree in Nursing is required.

Desired Qualifications

• Demonstrated experience in providing education to multiple stakeholders.
• Certification in a role or specialty through a nationally recognized professional nursing certification body is desired.
• Experience with care coordination for patients across the spectrum of different specialties.
• Demonstrated expertise spanning pediatric, adult, and geriatric care.
• Excellent written and verbal communication and interpersonal skills are required.
• Experience and knowledge with Medicare Guidelines of outpatient observation and 2 midnight rule is desired.
• Experience working with case management; utilization management; insurance contracts or knowledge of CPT and ICD-9/10 codes or clinical guideline systems such as Milliman© InterQual© or other similar system.
• Ability to work independently as well as within a team.

Position And Application Details

In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” to the submission:

• Cover Letter
• Resume

Job openings are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended.

Successful candidates will be required to self disclose any conviction history and will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.

For additional questions, please contact [email protected]

Additional Information

• Classification Title: Nurse Clinician
• Appointment Type: SEIU
• Schedule: Full-time

Compensation

• Pay Level: 7

Contact Information

• Contact Email: [email protected]
• Organization: Healthcare
• Contact Name: Seton Vinsand