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RN Manager of Utilization Review

Company: St. Rose Hospital
Location: Hayward
Posted on: May 3, 2022

Job Description:

JOB - SUMMARY: -The Manager of Case Management and Social Services is responsible for the development of staff and systems to effectively operate a comprehensive Case Management and Social Service Program. Provides leadership and supervision to case managers, social workers, and case management coordinators. Provides for service organization and operation, program development, and administrative oversight. Assures the efficient delivery and quality of services provided is consistent with professional standards of Case Management, Social Services, and Discharge Planning.

Duties and Responsibilities
Assists in clinical reviews utilizing criteria approved by the Utilization Review Committee. Determines priorities in which patients need to be reviewed.
Applies appropriate clinical judgment in the review process to ensure that information in the medical records meets the criteria for the intensity of care level of service for continued hospital stay and/or discharge.
Develops and implements department policies, procedures, and standards.
Interviews, selects, hires, evaluates, and provides orientation and training of new employees.
Develops/Participates in Organization Improvement Plan activities in accordance with overall hospital policy.
Facilitates effective time management among all Case Management/Social Services staff; identifies and effectuates systems for the provision of services that are most efficient.
Encourages continuing education at all levels and the sharing/exchange of skills and knowledge among all Case Management/Social Services rehabilitation staff to foster a goal of excellence.
Evaluates staff development and educational needs and identifies appropriate resources as necessary.
Reviews the performance and skills of professional and support staff annually and ensures appropriate disciplinary action within hospital policies and procedures.
Identifies needed resources and makes those needs known to the organization. Plans and participates in the clinical supervision of students and volunteers as appropriate.
Participates in planning social work components in selected hospital programs.
Prepares each fiscal year's Operating, Capital Expense Budget, and Salary Budget.
Provides Administration with monthly variance reports.
Assists in conducting orientation programs for new nursing hospital personnel.
Plans, organizes, and delivers in-service educational program Case Management/Social Services staff at least four times a year.
Provides consultation to physicians and hospital staff regarding psychosocial issues and discharge problems.
Develops and recommends programs as needed and implements the same to improve quality and cost-effectiveness.
Keeps abreast of current trends and developments as related to Case Management/Social Services, discharge plans, and home health.
Suggests and introduces new methods and techniques.
Participates in professional activities in order to continue their own professional development and contribute to that of the profession.
Demonstrates competence in the skills within the scope of practice including age and condition appropriate considerations.
Integrates with various departments in order to enhance patient outcomes.
Performs other duties as assigned or required.

1. Current CA RN license required.
2. BSN required.
4. Current Basic Life Insurance (BLS) required.

Vaccine requirement
To protect the health of our patients and our health care workers, and to preserve the safety of the St. Rose Hospital healthcare environment, we require all health system employees, trainees, volunteers, and others who regularly work within the health system to be fully vaccinated against COVID-19, including booster.

Keywords: St. Rose Hospital, Hayward , RN Manager of Utilization Review, Executive , Hayward, California

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