Telephonic Utilization Management Nurse Team Leader (RN)

Are you ready for a DIFFERENT type of NURSING?  A more FLEXIBLE schedule? Is it possible to have a GOOD WORK/LIFE BALANCE? Are you open to a working as part of a TEAM that pulls EXPERIENCE to find creative solutions? Do you have that drive to continue to LEARN more?

At Sheakley, we engage your unique talents and perspectives, and welcome your ideas on how to do things differently and better. In your efforts to achieve, learn and grow, we support you all the way.

Sheakley UniComp is currently seeking a Telephonic Utilization Management (UM) Nurse Manager to join our team! The UM Nurse Team Lead is responsible for collaborating on medical treatment requests and outcomes to achieve a successful return to work for injured workers in the state of Ohio.  This position will act as a resource for The Utilization Management Nurses and will be the first point of contact for clinical clarification/education/staffing of the UM team.

No more shift work, late hours or physical labor and all work is conducted over the phone. You’ll participate in a multi-facet training program to help nurture your keen knowledge and be ready and have the tools ready to make a difference in yet another type of nursing. Sheakley is a terrific place for those looking for continued growth. This is a unique opportunity to be a key part of a growing company and a dynamic team.

ROLE AND RESPONSIBILITIES:

  • Direct Clinical supervisor for UM Nurses
  • Reports to the Director of Medical Management
  • Acts as a resource for the Utilization Management Teams
  • Responsible for overseeing day to day Utilization management procedures
  • Develops and maintains a working relationship with all staff in other departments
  • Provides guidance and oversight for clinical operational aspects of the Utilization Management programs
  • Acts as a resource for the Utilization Management Nurses (first point of contact for clinical clarification/education/staffing)
  • Assists in development, coordination and implementation of orientation and in-services for the Utilization Management Nurses
  • Actively participates in the development of clinical guidelines and incorporates process into the Utilization management role
  • Assesses work queue distribution status; assigns and reassigns work to ensure timeliness and equitable distribution of work
  • Maintains current UM process guidelines and provides input on UM practices related to compliance with Managed Care Organization (MCO) Policy & Procedure, Bureau of Workers Compensation (BWC) Guidelines, & Official Disability Guidelines.
  • Ability to function as a Utilization Management Nurse and any other duties as assigned
  • Ensures Sheakley employs qualified clinicians accountable to Sheakley for decisions affecting injured workers
  • Responsible for establishing an internal and external network of resources
  • Act as a liaison between providers, customers, BWC and Sheakley UniComp for complaint resolution/clarification of processes
  • Consults with the Medical Director and the Senior Clinical Staff on all pertinent issues and establishes a working relationship with the Medical Director to support and uphold the established HPP guidelines and URAC standards
  • Maintains current knowledge applications of the BWC Policy Reference Guide (PRG) and serves as the main resource of the guidelines outlined in the BWC PRG and any changes to these guidelines.
  • Can demonstrate an understanding of BWC fee schedule and billing and reimbursement manual
  • Maintains communication with the Director of Operations, Director of Client Programs, and Director of Medical Management as to planning processes which effect Administrative Staff
  • Demonstrates effective communication methods and skills, using lines of authority appropriately
  • Provides Director of Medical Management with appropriate reports regarding the Utilization Management department
  • Available to assist in any extra duties assigned by the Director of Medical Management
  • Practice nursing within the Scope of Practice as designated by the State of Ohio Board of Nursing
  • Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.
  • Maintains current knowledge and application of MCO policy & procedures directly and indirectly related to UM processes
  • Participates on the Total Quality Management (TQM) committee

Job Requirements

QUALIFICATIONS:

  • A valid professional current unrestricted license for RN in the State of Ohio
  • Have a minimum of three years of full time post graduate direct patient care experience in a health and human services profession; preferably in occupational health or rehabilitation
  • At least 3 years of supervisory or management experience as an RN
  • Previous experience in Workers’ Compensation; prefer at least 1 year experience in Utilization Management (UM) and/or Case Management (CM)
  • Demonstrated leadership and communication skills
  • Maintain continuing education for licensure and certification
  • Excellent leadership, verbal/written communication skills, strong organizational skills, and excellent decision making and judgment, understands and upholds Sheakley’ s philosophy and demonstrates commitment to the Core Values
  • Demonstrates self-directed learning and participates in continuing education for Professional development

This job description is not intended to be all inclusive and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required.

EQUAL OPPORTUNITY POLICY:  It is our policy to seek and employ the best qualified personnel and to provide equal opportunity for the advancement of employees, including upgrading, promoting and training and to administer these activities in a manner which will not discriminate against any person because of race, color, religion, age, sex, marital status, national origin, disability or any other basis prohibited by law.