Director Clinical Resource

Position Description:

The coordinator has the responsibility of utilization review for EMC. The coordinator assists hospital leaders, physicians, and staff to evaluate the efficiency of patient care systems. Both over- and under-utilization of resources will be assessed. Enhanced efficiency and effectiveness in patient care systems will improve quality and reduce the cost of patient care delivery. The Utilization Review Coordinator will continue to research and participate in the development of new and innovative approaches to utilization and resource management. To promote the efficient utilization of beds and services through concurrent and retrospective reviews of the necessity for inpatient admission, appropriate length of stay and timely and appropriate use of diagnostic and therapeutic services.

Minimal Qualification:

Experience:

 Three years nursing experience in medical/surgical areas. Experience in managed care, home health, hospice or pubic health highly preferred.

Education:

Registered nurse with valid state license required. Knowledge of current nursing principles, techniques and procedures. Knowledge of hospital routine as it relates to admission and third-party reimbursement.

Special Qualifications:

Knowledge of current utilization management principles, third party payer review requirements, age-specific principles, discharge planning process. Excellent communication skills. Knowledge of clinical databases and strong assessment skills. Ability to establish smooth working relationships with physicians and their office staff. Ability to work with ancillary hospital staff.

Outside Relationship: Professional associations. Managed Care, UM/QM organizations.

Physical / Mental Demands:

1. Ability to think and work effectively under stress with frequent interruptions; to move, sit, stand, walk and bend intermittently throughout the work day, lift and/or move to 25 pounds.
2. Must posses sight and hearing senses or use prosthetics that will enable these sources to function adequately so that the requirements of this position can be fully met.
3. Use of mechanical and technical equipment required for the responsibilities assigned.
4. External and internal applicants who become disabled, must be able to perform the essential job functions either unaided or with the assistance of a reasonable accommodation to be determined on a case by case basis.
5. Position has a moderate expected exposure to blood borne pathogens. (moderate)

The duties, responsibilities and required skills for this role are outlined on the following pages and are the basis for competency and performance evaluations. This list is intended to describe the general nature of work to be performed and not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.