ASSISTANT NURSE MANAGER - UM at Aultman Health Foundation – CANTON, Ohio

Position Summary:

The Assistant Nurse Manager (ANM) of Utilization Management will provide daily oversight of the hospital’s Utilization Management department. The ANM assists with the management of daily operations, which includes, but is not limited to, supervising the staff performing utilization management activities, staffing & scheduling, and attending required departmental and organizational meetings. The goal is to support the achievement of utilization goals through effective management, communication and role modeling. The ANM functions as the internal resource on issues related to the appropriate allocation of healthcare/hospital resources and utilization review and management activities. The ANM is responsible for carrying out assignments in a manner to assure success in financial management, human resource management, leadership, quality and operational management objectives. The ANM participates in program development and unit-specific performance improvement. The ANM consistently demonstrates the core values of Aultman Hospital and serves as a role model to other employees. The ANM adheres to the Aultman Hospital Mission Statement.

Department Summary:

The Utilization Management program of Aultman Hospital will promote appropriate allocation of healthcare/hospital resources while maintaining high quality patient care through concurrent and retrospective reviews of the medical necessity of inpatient admission and outpatient observations. Reviews take into consideration severity of illness, intensity of services, length of stay, level of care and discharge plan. The Utilization Management department oversees the process of evaluating and monitoring the medical necessity, appropriateness, and efficiency of treatments, procedures, and services provided to hospitalized patients.

Job Qualifications:

• Graduate of approved School of Nursing; BSN preferred
• Current unrestricted RN licensure in the State of Ohio
• Five years’ recent experience in the acute care setting
• Certification in UR, Case Management, Quality or related field preferred
• Refined communication skills, both written and oral
• Knowledge of basic computer program skills including Excel and PowerPoint
• Knowledge of/experience in Managed Care concepts in relation to financial aspects of patient care
• Must be able to cope with the emotional and mental stress of the position and deadlines imposed on specific duties
• Refined organizational skills with well-developed style of diplomacy and assertiveness
• Able to demonstrate critical thinking skills, problem-solving abilities and an understanding of systems and change process
• Able to function autonomously, displaying personal integrity and always maintaining confidentiality
• Able to work with all levels of the multidisciplinary healthcare team
• Refined negotiating skills and the ability to deal with conflict resolution
• Dresses in professional manner, wearing either lab coat or jacket when in the clinical setting

Job Skills:

• Ability to interact with patients, employees, and others in professional manner
• Ability to receive, understand, and implement direction from supervision and management
• Ability to effectively function within the framework of department and organizational policies and procedures.
• Detail oriented
• Communicate effectively
• Adaptability to changing work environment or needs

Responsibilities & Expectations:

• Respects patients’ rights and responsibilities
• Is courteous in dealing with all customers, whether external or internal
• Demonstrates compassion and sensitivity to all customers
• Shows respect for the customer’s culture, language customs and beliefs
• Maintains high standards of ethical and professional behavior
• Actively participates in quality improvement activities within the department
• Utilizes available educational resources to maintain and develop knowledge and skills related to field of practice
• Demonstrates proficiency in the application of InterQual criteria
• Demonstrates knowledge and understanding of CMS rules and regulations as they pertain to Utilization Management under the Conditions of Participation
• Works closely with ED providers and actively oversees assignment of Observation status and manages status issues related to this service
• Works closely with medical and surgical providers and actively evaluates the appropriateness of Observation status assignment and potential for reclassification of status
• Oversees patient’s clinical progress to assure appropriate use of resources and timely care delivery
• Provides information to meet external payer requirements to ensure hospital reimbursement
• Identifies and participates in the development and implementation of strategies to reduce unnecessary resource consumption and length of stay on assigned patient population
• Monitors delays in care and discharge, actively intervening as appropriate to eliminate delays and provide timely access to care and services
• Collaborates with medical staff and other members of the healthcare team to ensure effective, efficient delivery of care and services
• Communicates, both verbal and written, post-hospital care needs and plan to all members of the healthcare team
• Functions as a resource to medical staff and hospital staff regarding regulatory and payer requirements
• Communicates concerns to other areas within the hospital as appropriate (Performance Improvement, Infection Control, Risk Management)
• Functions as a team member, working closely with Social Workers, RN Case Manager, precertification/verification specialists to promote positive patient outcomes
• Identifies opportunities for inter and intradepartmental operational improvements
• Provides coverage for team members as needed
• Participate in regular meeting forums
• Develops educational opportunities for staff
• Assists in development and review of hospital policies according to best practice measures
• Participate in Performance Improvement activities and monitors Quality indicators as applicable
• Manages assigned projects including initiation, follow-through and completion
• Serves as an active member of the department’s leadership team, working with the executive(s) and physician(s) to ensure the clinical and budgetary efficiency of the department
• Supervises, evaluates, guides and counsels’ staff in their work performance
• Participate in action planning for staff development
• Other duties as assigned

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status.

Working Conditions:

• Work 8-12 hours per day, adjusting hours to meet unit and customer needs
• This department requires daily coverage, 7 days per week
• Weekend and holiday rotation is assigned
• Hybrid/WFH schedule may be available based on staffing and the needs of the unit
• Must be in good physical and mental health and maintain an excellent attendance record
• Lunch periods and breaks are coordinated with other staff members to maintain adequate unit coverage
• Must adhere to hospital policies and procedures
• Must fulfill position description requirements
• Is subject to frequent interruptions during performance of duties

Hazardous Exposure Category:

Category III- Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way.