UM RN Team Lead - Utilization Management - Miamisburg - FT/Days
Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio.
We are committed to transforming the health care experience with high-quality care for every stage of life.
Our service-oriented mission is in action every day, whether its by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
Kettering Health Miamisburg Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years.
Kettering Health Miamisburg, formerly Sycamore Medical Center, is a full-service hospital located minutes west of the Dayton Mall on Miamisburg-Centerville Road off I-75 in Miamisburg, Ohio.
The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care.
Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning.
142 bed facility Awarded with 100 Top Hospital by IBM Watson Health for the 10th time in 2019.
In 2020, KH Miamisburg received an A from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.
Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.
KH Miamisburg received several awards from Healthgrades:
Outstanding Patient Experience Award (2017-2019) Americas 100 Best Hospitals for Prostate Surgery Award (2020) Joint Replacement Excellence Award (2020) KETTERING HEALTH NETWORKJOB DESCRIPTION TEMPLATEJob SummaryServes as a resource for staff with any Utilization Management (UM) issues, coordinates staff orientation and education with UM denial specialists and UM Manager.
Coordinates ongoing UM education utilizing lunch and learn opportunities while exploring other options for UM education.
Responsible for daily UM assignments.
Participates in departmental audits.
Assist with utilization review processes as needed.
Oversees UM/RNs to provide day to day supervisory oversight for UM activities.
Two UM Coordinators work cohesively.
Perform other duties as assigned.
Job Requirements Education Registered Nurse from an accredited school of professional nursing with a license to practice in the State of Ohio.
BA/BS/BSN from an accredited school required.
Experience may be consideredWork Experience Minimum of 5 years clinical experience required.
Minimum of 2 years experience in utilization managementLicenses, Certifications and Registrations RN degree from an accredited school of professional nursing with active license to practice in the state of Ohio MCG Certificationmust be willing to obtain within 12 monthsSkills Computer skills required Good knowledge of Epic Strong organizational skills with a high level of accuracy and attention to detail Strong presentation skills with the ability to feel comfortable in presenting/defending audit logic to key stakeholders.
Must have excellent leadership, interpersonal, organizational, and communication skills.
Good knowledge of MCGEssential Functions Oversees day to day supervisory oversight for UM/RN activities Completes clinical reviews for payors First line resource to UM staff for process/workflow clarification Creates daily assignments for UM team Works in conjunction with other UM team lead Coordinates orientation and ongoing UM educationNew Hire/Annual Competencies Demonstrates appropriate use of MCG guidelines Completes assigned educational modules Provides ongoing feedback to UM Manager regarding staff performance and practice issues Participates in departmental audits Demonstrates the ability to encourage and aide UM staff with ongoing development in their roleLeadership Capabilities (if applicable) Provides support and acts as resource to UM staff in managing payor reviews.
Coordinates staff education/orientation in conjunction with UM leadership Promotes positive morale and support of UM team.
Works to integrate UM team to follow appropriate processes/workflows and encourages ongoing development for success.
Requisition Number:
2023-44398Shift:
Varied ShiftName:
705493 - UTILIZATION MANAGEMENTExternal Company URL:
http:
//www.
ketteringhealth.
org/Street:
1 Prestige PlaceFTE:
80 Hours Per Pay Period/FTE 1.
0 Recommended Skills Utilization Management Managed Care Nursing Home Care Registered Nurse Disease Management Hospitalization Estimated Salary: $20 to $28 per hour based on qualifications.
We are committed to transforming the health care experience with high-quality care for every stage of life.
Our service-oriented mission is in action every day, whether its by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
Kettering Health Miamisburg Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years.
Kettering Health Miamisburg, formerly Sycamore Medical Center, is a full-service hospital located minutes west of the Dayton Mall on Miamisburg-Centerville Road off I-75 in Miamisburg, Ohio.
The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care.
Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning.
142 bed facility Awarded with 100 Top Hospital by IBM Watson Health for the 10th time in 2019.
In 2020, KH Miamisburg received an A from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.
Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.
KH Miamisburg received several awards from Healthgrades:
Outstanding Patient Experience Award (2017-2019) Americas 100 Best Hospitals for Prostate Surgery Award (2020) Joint Replacement Excellence Award (2020) KETTERING HEALTH NETWORKJOB DESCRIPTION TEMPLATEJob SummaryServes as a resource for staff with any Utilization Management (UM) issues, coordinates staff orientation and education with UM denial specialists and UM Manager.
Coordinates ongoing UM education utilizing lunch and learn opportunities while exploring other options for UM education.
Responsible for daily UM assignments.
Participates in departmental audits.
Assist with utilization review processes as needed.
Oversees UM/RNs to provide day to day supervisory oversight for UM activities.
Two UM Coordinators work cohesively.
Perform other duties as assigned.
Job Requirements Education Registered Nurse from an accredited school of professional nursing with a license to practice in the State of Ohio.
BA/BS/BSN from an accredited school required.
Experience may be consideredWork Experience Minimum of 5 years clinical experience required.
Minimum of 2 years experience in utilization managementLicenses, Certifications and Registrations RN degree from an accredited school of professional nursing with active license to practice in the state of Ohio MCG Certificationmust be willing to obtain within 12 monthsSkills Computer skills required Good knowledge of Epic Strong organizational skills with a high level of accuracy and attention to detail Strong presentation skills with the ability to feel comfortable in presenting/defending audit logic to key stakeholders.
Must have excellent leadership, interpersonal, organizational, and communication skills.
Good knowledge of MCGEssential Functions Oversees day to day supervisory oversight for UM/RN activities Completes clinical reviews for payors First line resource to UM staff for process/workflow clarification Creates daily assignments for UM team Works in conjunction with other UM team lead Coordinates orientation and ongoing UM educationNew Hire/Annual Competencies Demonstrates appropriate use of MCG guidelines Completes assigned educational modules Provides ongoing feedback to UM Manager regarding staff performance and practice issues Participates in departmental audits Demonstrates the ability to encourage and aide UM staff with ongoing development in their roleLeadership Capabilities (if applicable) Provides support and acts as resource to UM staff in managing payor reviews.
Coordinates staff education/orientation in conjunction with UM leadership Promotes positive morale and support of UM team.
Works to integrate UM team to follow appropriate processes/workflows and encourages ongoing development for success.
Requisition Number:
2023-44398Shift:
Varied ShiftName:
705493 - UTILIZATION MANAGEMENTExternal Company URL:
http:
//www.
ketteringhealth.
org/Street:
1 Prestige PlaceFTE:
80 Hours Per Pay Period/FTE 1.
0 Recommended Skills Utilization Management Managed Care Nursing Home Care Registered Nurse Disease Management Hospitalization Estimated Salary: $20 to $28 per hour based on qualifications.
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