Utilization Management RN

Vitalcore Health Strategies • Hopkinton, MA

395d

About The Position

The Utilization Management RN at VitalCore Health Strategies plays a crucial role in advocating for optimum healthcare for an incarcerated population. This position involves serving as a Regional Office Case Manager, coordinating with healthcare team members, and ensuring the effective implementation and evaluation of patient care plans. The RN will also be responsible for reviewing patient care aspects, managing referrals for offsite treatment, and overseeing hospitalized cases to maintain continuity of care.

Requirements

• Graduate of an accredited School of Nursing.
• Licensure as a Registered Nurse in the state of employment with 1+ years of experience or as an LPN with 5+ years of experience.
• Preferred experience in Med Surg, Case Management, and/or Discharge Planning.
• Possesses an active CPR certification.
• Remains knowledgeable about specific state laws and regulations governing practice.
• Satisfactory completion of initial and annual clinical competencies to demonstrate aptitude as assigned by role.

Responsibilities

• Serve as a Regional Office Case Manager for an incarcerated population, advocating for optimum healthcare.
• Maintain accurate, detailed reports and confidential records.
• Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans.
• Modify patient treatment plans as indicated by patients' responses and conditions.
• Review all aspects of facility patient care.
• Review referrals for offsite treatment and care for appropriateness and best utilization of resources.
• Act as a liaison with all offsite providers, both specialty and hospitals.
• Review medical transports to Emergency Departments to ensure continuity of care.
• Oversee hospitalized cases, including reviewing daily clinicals and providing information to facility MD and team.
• Assist with hospital discharge planning to ensure goals of care are met.
• Seek infirmary level bed placement when care is needed on a higher level.
• Perform additional duties as assigned by the regional office.

Benefits

• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Employee assistance program
• Vision insurance
• Life insurance
• Pet insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree