Physical Health UM Training & Systems Coord-RN (Hybrid)

Partners Health Management; Elkin (NC); Hybrid; USD 60,000 - 75,000; Full time

Job summary

Partners Health Management offers an exciting opportunity for a Physical Health UM Training & Systems Coord-RN in a hybrid role. This position involves managing complex projects, providing training, and ensuring compliance with clinical policies while allowing for collaboration with various teams. The ideal candidate will be a fully licensed nurse with strong data analysis skills and experience in utilization management.

Benefits

Annual incentive bonus plan

Medical, dental, and vision insurance

Generous vacation and sick time accrual

12 paid holidays

State Retirement (pension plan)

401(k) Plan with employer match

Company paid life and disability insurance

Wellness Programs

Public Service Loan Forgiveness Qualifying Employer

Qualifications

• Must be a fully licensed nurse in North Carolina.
• 2 years of experience with clinical systems and/or system analytics required.
• Excellent computer skills and proficiency in Microsoft Office.

Responsibilities

• Manage departmental projects assigned.
• Oversee implementation of upgrades/changes to the authorization system.
• Participate in internal/external reviews.

Skills

Communication

Data analysis

Interpersonal skills

Problem solving

Education

Fully Licensed Nurse in North Carolina

2 years’ experience with clinical systems

Tools

Microsoft Office Products

Job description

Physical Health UM Training & Systems Coord-RN (Hybrid)

Join to apply for the Physical Health UM Training & Systems Coord-RN (Hybrid) role at Partners Health Management

Physical Health UM Training & Systems Coord-RN (Hybrid)

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Join to apply for the Physical Health UM Training & Systems Coord-RN (Hybrid) role at Partners Health Management

Competitive Compensation & Benefits Package!

Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer
  
  

See attachment for additional details.

Office Location: Hybrid; Available for any of Partners' NC locations

Closing Date: Open Until Filled

Primary Purpose of Position: This position manages complex projects, provides system support and training, and ensures compliance with all accrediting bodies and contractual requirements For Physical Health Utilization Management (PHUM). This role requires understanding of information systems, as well as knowledge of data integration, clinical policies, and UM policies and procedures. This position works in collaboration with the UM Leadership Team, with concentration on Physical Health Benefits, UM Systems Team, and Care Transitions Team. This position requires a dynamic, proactive approach, evaluation and monitoring to ensure quality supports and consistent adherence to NC DHHS contract requirements.

Role And Responsibilities

• Manages departmental projects assigned by the Senior Director of PH Utilization Management and Transitional Care
• Represents department in interdepartmental data strategy workgroups and committees.
• Acts as departmental liaison for all information system related matters and oversees the implementation of upgrades/changes to the authorization system, including staff and provider training.
• Monitors effectiveness of systems and guidelines through review of data and addresses identified issues/concerns.
• Is responsible for creating, presenting, and implementing necessary changes/updates to the systems.
• Ensures quality customer service is provided through all activities.
• Completes quality monitoring of required reporting requirements, including operational reporting and performance indicators.
• Participates in internal/external reviews and ensures follow-up is completed as needed.
• Promotes a spirit of active collaboration with others both internally and externally, with focus on and positive outcomes for individuals supported.
• Coordinates and collaborates in the development of Utilization Management guidelines, policies and procedures, departmental strategic plan initiatives and outcomes, making recommendations for improvements.
• Takes a leadership role in the effectiveness of UM workflows, identifies improvement actions, as necessary, and makes recommendations to UM Leadership
• Acts as departmental liaison for NCQA accreditation and EQR/Compliance reviews and oversees implementation of activities related to preparations for audits and any resulting corrective action plans.
• Assists in facilitation and Implementation of Electronic Visit Verification (EVV) process
• Assists in facilitation and implementation of Transition of Care (TOC) files
• Participates in workgroups and committees with other Partners staff as assigned.
• Acts as liaison with Quality Management for quality/monitoring activities.
• Provides leadership, in collaboration with managers, to promote strong cohesiveness among all company employees regardless of department, role or office location…promotes one vision, one voice.
• Periodically attends team meetings facilitated by Supervisors if applicable, travels to office locations for supervision, etc. to promote rapport and comfort level among all team members.
• Performs other duties as assigned.
  
  

Knowledge, Skills And Abilities

• Considerable knowledge of applicable Clinical Coverage Policies as related to the Physical Health UM team.
• Considerable knowledge of UM policies and procedures.
• Strong, working knowledge of data analysis methodologies.
• Ability to exercise appropriate judgement and discretion in presenting information.
• Ability to present complex information to varying audiences, both internal and external, in a professional and clear manner.
• Knowledge of program practices, techniques, and technology sufficient to support the program.
• Knowledge of the goals and objectives of the work unit and an understanding of the structure and functions of the organization (must have knowledge of staff assignments/commitments, and the functions of other internal and external organizational segments whose work impacts on the unit or with which work must be interfaced).
• Excellent computer skills; proficient in Microsoft Office Products (Word, Excel, Outlook, Publisher); experience in use of databases.
• Ability to practice effective communication techniques, oral and written.
• Ability to establish and maintain effective interpersonal and working relationships with internal and external customers.
• Ability to analyze and interpret policy and procedural guidelines and to resolve problems and questions, independently.
• Ability to complete non-routine activities and tasks that require deviation from established procedures which includes the ability to choose the appropriate course of action and recognize the existence of and differences among situations.
• Ability to use initiative and judgment in resolving problems not covered by established priorities or prior experience.
• Ability to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisor.
• Ability to manage and uphold integrity and confidentiality of sensitive data.
• Exceptional interpersonal skills.
• Problem solving and conflict resolution skills.
  
  

Education/Experience Required: Fully Licensed Nurse in the state of North Carolina with at least 2 years’ experience with clinical systems and/or system analytics. Must have the ability to travel as needed to perform the job duties.

Education/Experience Preferred: Previous professional experience with Medicaid Managed Care. Previous experience in Utilization Management.

Licensure/Certification Required: Fully Licensed Nurse in the state of North Carolina. Employee is responsible for complying with respective licensure board’s continuing education/training requirements in order to maintain an active license.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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