UM Team Lead RN

The Team Leader is responsible for oversight of staff UM RNs to ensure coordination and function of a team across the continuum during the patient's acute, chronic and long-term stages of illness for a defined patient population. This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. The role is on-site at Kennestone Hospital and collaborates with all team members to optimize hospital's throughput, length of stay, and reimbursement accuracy.

What You Will Do

You will oversee daily staffing, coach staff productivity and denial ratios, and manage QA & PI activities. You will initiate assessments for necessity and appropriateness of health services using screening criteria, collaborate with physicians and physician advisors for resolution, and ensure timely and accurate certification of hospital admissions. You will also deliver and explain legally required documents in person, such as condition-code 44 or Medicare observation notices (MOON), and proactively identify avoidable days to minimize financial loss.

Why It Might Be a Fit

This role requires a minimum of 3 years clinical practice experience and 1-2 years of UM/Case management/Care Coordination experience. You should have knowledge of the Case Management process, excellent organizational and professional communication skills, and the ability to effect change and perform critical analysis. The position offers the opportunity to work in a supportive environment with a focus on meaningful work and a rewarding life.

Requirements

• Minimum 3 years Clinical Practice/Experience
• Minimum 1 year with one to two years of UM/Case management/Care Coordination experience
• Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing
• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact
• BLS - Basic Life Support or BLS-I - Basic Life Support - Instructor or ARC-BLS - Amer Red Cross Basic Life Support
• Knowledge of Case Management process
• Excellent organizational and professional communication skills
• Knowledgeable in utilizing screening criteria in review of clinical data
• Ability to effect change and perform critical analysis