Care Manager Utilization Review

Get To Know Summit Pacific Medical Center
Your trusted partner in Health and Wellness, Summit Pacific is a vibrant and expanding public hospital district that operates a Critical Access Hospital with a Level IV trauma designation, three rural healthcare clinics, and a seven-day-a-week urgent care clinic. Our vision is "Through Summit Care, we will build the healthiest community in the Nation." Our hospital is unique due to its size and accessibility. We pride ourselves on our ability to give patients quick access to a provider.

• Critical Access Hospital
• 24/7 Emergency Department
• Level II Cardiac Center
• Level III Stroke Center
• Level IV Trauma Care

To learn more about Summit Pacific, visit

Pay Range (depending On Experience)
$ $69.84

Job Summary
As a member of a multidisciplinary team, the Care Manager will be responsible for coordination of care and utilization of services for acute care and post-acute skilled patients. The Care Manager will work collaboratively with interdisciplinary teams both internal and external to the organization with a shared vision to improve patient care to achieve optimal clinical and financial outcomes.

Job Duties And Responsibilities

• Continually assesses the appropriateness and timeliness of level of care, assures appropriate utilization of resources by evaluating care needs and resources available.
• Collaborate with interdisciplinary team to achieve optimal and cost-efficient patient care outcomes that reflect patient preferences and values.
• Collaborate daily with the interdisciplinary care team to support the assessment of continued need for acute hospitalization and post-acute skilled care. Round with and meet with patients to perform needed assessment and follow-up.
• Contribute to the development and implementation of a goal-directed, age-appropriate plan of care. Facilitate care coordination needs to support plan of care from admission through to discharge.
• Collaborate with internal and external resources to facilitate a safe transition from hospital to another facility or home with appropriate services. Identifies discharge barriers and initiates action to resolve.
• Ensure patient and family understanding of third-party payer guidelines to arrange appropriate referrals.
• Provides clear, timely and thorough documentation based on established department standards.
• Facilitates coordination for concurrent denials, including nurse or provider peer to peer.
• Performs patient care, where competent and assists in coordination of care efforts.
• Adapts to changes in the work environment. Engages others in understanding the reason for change and leads them to identify the path forward.
• Builds and maintains working relationships. Maintains strong working relationships and engenders trust and credibility through effective and professional interactions.
• Creates positive experiences for patients, customers, and co-workers.
• Demonstrates ongoing learning & development. Participates in ongoing skills training, competency development, and professional development.
• Facilitates teamwork. Actively engages in team activities. Welcomes and supports new team members; promotes a positive work environment.
• Fosters an environment of trust. Maintains open and honest communication. Protects privacy and confidentiality. Follows through on commitments.
• Provides thoughtful and constructive input for strategic planning. Participates in departmental/functional strategies and tactics.
• Special projects as assigned.

Organizational Responsibilities
In addition to the duties and responsibilities listed above, all employees are expected to support the Summit Pacific Medical Center mission, vision and values; comply with SPMC policies and procedures; and conduct themselves in an ethical, professional, respectful, and collaborative manner at all times.

Required Qualifications

• 2 years Registered Nursing experience in Acute Care hospital and/or care management or utilization review experience in any setting.
• Current WA or Multistate RN License
• Current BLS

Preferred Qualifications

• Bachelor's degree in Nursing
• Current Care Manager Certification

Required Knowledge, Skills, Abilities

• Strong organizational skills; ability to prioritize, and reprioritize, work as needed to meet objectives.
• Professional and effective written and verbal communication skills. Ability to identify and employ communication strategies appropriate to the audience. Grammar and punctuation skills as needed to compose professional documents.
• Proficient in the use of current technology and software, including intermediate to advanced Microsoft Office skills (Word, Excel, Outlook).
• Proven ability to handle confidential information with discretion. Ability to develop and maintain accurate documentation and records.
• Demonstrated teamwork and collaboration skills. Strong customer service and interpersonal skills; ability to maintain composure and interact calmly and professionally with co-workers, providers, patients and visitors in a fast-paced, high-stress environment.
• Ability to work independently using good judgment, problem-solving, organization, and prioritization skills to complete assignments in a timely, accurate, and effective manner.

Work Shift
Exempt Staff

Working Location:
Elma, Washington

Benefits
Our uniquely designed benefits are here to support you and your family in staying well, growing professionally and achieving financial security

We take care of you, so you can focus on delivering our mission of caring for everyone, especially the most vulnerable in our communities.

Benefits Offered By SPMC

• Competitive Compensation
• Medical
• Prescription
• Dental (including Orthodontia)
• Vision
• Healthcare FSA and daycare FSA
• Daycare subsidized benefit
• Life Insurance
• Accidental Death and Dismemberment (AD&D)
• Short- and long-term disability
• Generous employer 403b match contributions for retirement
• 457 retirement