The nurse uses clinical skills to coordinate, document and communicate all aspects of the utilization management program. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Utilize analytical skills and advanced assessment skills necessary to assess a patients condition and utilize that data through the nursing process and clinical judgment to provide comprehensive patient care.
Under the direction of the Clinical Manager assists in managing the human, physical, and financial resources to deliver optimal quality care to patients and education for their families by assuring continuity and integration of services during the provision of care and services.
Must be able to provide, manage, and coordinate patient care and services through interpersonal contact which allows patients to attain or maintain the highest practicable physical, mental, and psychosocial well-being.
Oversees admission, discharges, throughput, care quality and most shift operational activities. Supervises nursing service activities in patient unit for the duration of one shift and/or in the absence of the manager.
Assumes responsibility and accountability for facilitating, communicating, and collaborating with both the healthcare team, and the patient/family to identify and meet the physical, emotional and spiritual needs of the patient.
Providers are expected to round in the hospital to further support the Behavioral Health program to include substance abuse program, Employee Assistance Program and integrated Behavioral Health programs.