Job Description
JOB SUMMARY Your accomplishments and expertise are noteworthy. They're worth taking to the next level at **MEMBERS ONLY**SIGN UP NOW***, a Joint Commission-accredited organization that has earned distinguished accolades for clinical excellence, including Level 3 Patient-Centered Medical Home recognition from the National Committee for Quality Assurance.
Utilizing a collaborative process, the Utilization Analyst (UA) will assess, plan, monitor and evaluate all pertinent clinical, psycho-social, and medical information and criteria (Interqual) to assist in determination of the initial and concurrent plan of care for all patients presenting to CMC for intervention. The UA will ensure the utilization of appropriate and timely intervention being the steward of resources for all populations.
Conducts a thorough assessment utilizing approved criteria, protocols, pertinent information available through Plan of Care (POC), patient demographics, Interqual criteria, multidisciplinary rounds (MDRs), consultations, and payor source. Applies approved criteria, protocols, UM acuity criteria, to monitor ongoing appropriateness of admission, level of care (LOC), and ongoing stay. Documents assessment based on department and criteria standards. Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes action to achieve continuous improvement in the throughput process.
This position requires the ability to work independently and exercise sound, clear judgment in interactions with physicians, payors, patients/families, internal CMC departments, and external resources. This position requires strong analytical, PC, organizational, and time management skills as evidenced by a capacity to prioritize multiple tasks daily. The position requires and understanding of physical/physiological characteristics of illness and/or impairment and the ability to extrapolate the information to a POC, as well as articulate the POC and question interventions as appropriate.
Excellent interpersonal, verbal and written communication and negotiation skills are a requirement, as well as a clear understanding of the SOP within CM/UM and managed care.
A regional leader based in Roanoke, Virginia, our community-based healthcare network includes seven hospitals‐including a U.S. News & World Report Top 10 hospital and two Magnet®-designated hospitals‐multi-specialty physician practices, and affiliations with prestigious academic medical institutions. Note the worthy advantages of supportive leadership, shared decision-making, state-of-the-art technological resources, inter-professional teams, innovative learning, and advancement potential.
MINIMUM QUALIFICATIONS Education: Graduate of professional school of nursing required. Bachelor's Degree in Nursing preferred.
Experience: Minimum of three (3) years to five (5) years' experience in clinical healthcare setting with direct patient care responsibilities reflecting planning, coordination, delivery of needed services such as education, discharge planning and utilization management required.
Licensure/Certification: Current licensure in Virginia as Registered Nurse required. Case Management Certification preferred.
Other: Strong oral and written communication skills as well as effective interpersonal skills. Must be effective at teaching individuals from all socio-economic and cultural backgrounds. Must have ability to work without close supervision and demonstrate effective organizational abilities.
OUR VALUES Below are our core values that we strive to embody and expect of all our team members:
Collaboration: Working together with purpose to achieve shared goals.
Commitment: Unwavering in our quest for exceptional quality and service.
Compassion: Putting heart into everything we do.
Courage: Doing what's right for our patients without question.
Curiosity: Fostering creativity and innovation in our pursuit of excellence.
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. MAKE YOUR TOMORROW WITH US.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
