Summary: General: Assists the Director/Manager in the technical management by ensuring proper day to day operations of the area. Serves as a resource person for team members. Primary duties include ensuring compliance with policies/procedures and regulatory requirements, problem solving, teaching/training, and communication. Specific: Responsible for the area of Utilization Management.
Other information: Minimum two years in a related field.Able to communicate effectively, pleasantly, cooperatively, and discretely with patients, physicians, team members, and the general public. Able to work under pressure and maintain patient confidentiality. Excellent communication skills and ability to relate well with people of diverse backgrounds, training and experience. Demonstration of creativity, initiative and problem solving. .
Responsibilities: Demonstrates ability to plan and organize work flow to maximize productivity while maintaining quality, safety and customer satisfaction.. Assists in the development of PDCA systems to implement and monitor process improvements and take action where appropriate. Ensures team members maintain departmental policies/procedures, and adhere to all quality, safety, and regulatory standards/requirements. Supports department by monitoring regulatory/accreditation compliance. Takes actions to address deficiencies as appropriate. Trains new and current team members and students. Ensures that orientation and training checklists are completed. Makes sure that annual mandatory education is completed and competencies are assessed and documented. Provides feedback to leadership about team members' performance, including need for coaching, counseling, disciplinary action. Assists leadership in completing initial and annual performance appraisals. Recommends/Assists with the preparation of departmental training and education, quality and safety programs and performance improvement projects. Acts as resource person for daily operations within the department, section or unit. Very knowledgeable about the specific aspects/technical details of the job, and readily share knowledge with others. Participates in the interview process and provides feedback on candidates. Primary contact for Third Party Payers and Quality Insights of Delaware. Oversees the appeals and denials process. Oversees the Hospital Issued Notice of Noncoverage(HINN) process. Supports Utilization Review (UR) Committee by preparing quarterly reports related to utilization data and trends. Oversees the Condition 44 process. Reviews and provides supportive documentation related to Length of Stay (LOS) outliers. Provides Utilization Management education to hospital and medical staff. Responsible for monthly staffing schedule and daily staffing needs
Credentials: Essential: * RN - Registered Nurse
Competencies and skills: Essential: * Clear Communication Skills Both Written And Verbal * Able To Keep Confidential Information Regarding Patients, Team Members * Able To Withstand Crisis Situations * Has Skills To Provides Customer Service To Patients, Team Members And Visitors * Knowledge And Experience With Electronic Health Records * Experience With Excel, Power Point, Word, Visio, Etc.
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.