Job Description

Summary

While upholding the Star Valley Health mission, vision, and values, this key position is responsible for the effective management and operation of the utilization review and discharge planning endeavors. As advocates for the patients, you will also navigate the medical system and help patients and families understand their options. The responsibilities encompass compliance with CMS and state regulations and the overall direction of the quality management program. This will require keeping abreast of current medical laws, rules, and policies such as Medicare, Medicaid, and other health insurance. This position requires the ability to manage medical costs through timely prospective, concurrent, and retrospective review activities. This is an at-will position.

Job Duties

• Contributes to Quality Management program goals and objectives in containing health care costs and maintaining a high-quality medical delivery system
• Communicates directly with physicians to gather all clinical information to determine the medical necessity of requested healthcare services
• Reviews inpatient and outpatient services using Milliman Care Guidelines
• Recommends, coordinates, and educates providers, patients, and families regarding alternative care options
• Serves as a liaison and patient advocate when deemed applicable for quality of care and cost outcomes
• Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with insurance carriers
• Participates in quality improvement activities
• Works with staff/employees to analyze the patterns and trends to identify and determine whether a problem or opportunity for improvement exists
• Continual monitors of high risk and problem-prone areas
• Identifies and reduces risks of acquitting and transmitting infections among patients, employees, physician, and other independent practitioners, contract workers, volunteers, students, and visitors
• Develops, reviews and updates policies and procedures based on nationally recognized standards
• Assists with projects and tasks in the Quality Department as needed
• Performs other duties as assigned or needs arise

Requirements

Abilities & Skills:

• Strong communication, documentation, clinical and critical thinking skills essential
• Strong multi-tasking skills with the ease of changing directions upon request and needs
• Interpersonal and problem-solving skills necessary to interact with physicians, Board, leadership, employees, and the public
• Ability to work in a team-oriented environment, communicate effectively, and demonstrate sensitivity to patients, visitors, and staff
• Promote a cooperative and congenial work environment
• Proficient in Microsoft Office products such as Word, Excel, and Outlook. General Internet skills and use of a computer for clinical data entry/retrieval
• Comply with HIPAA and other federal, state and local regulations as well as maintain the highest degree of confidentiality in patient and staff matters
• Constant sitting, standing, walking, pushing, pulling, bending, reaching, and computer use throughout the day

Experience & Education:

• Current Wyoming RN or LPN license
• 5 years of clinical experience in a hospital setting preferred
• Working knowledge of utilization management preferred

Note: Position descriptions are intended to serve as a guideline for typical duties and requirements of a position, but are not inclusive. Additional or different responsibilities within a reasonable scope of the position description may be added or deleted any anytime at the discretion of the Board.

Compensation details: 33.68-50.54 Hourly Wage

PI80ed5baeb3ab-30492-35202965

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