DescriptionSummary: The RN Supervisor is accountable for supervising the delivery of high-quality, cost-effective care to patients. Responsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes and programs which enhance, strengthen and integrate the services comprising the nursing department. Responsible for participation in the development and implementation of the service line strategic business plans; and for creating an environment, which continuously supports improvement of operational, financial, and clinical components. Assumes primary responsibility for effective supervision of nursing activities of assigned area(s). Assists management of financial and human resources to ensure services meet established quality and productivity standards. Provides feedback and assistance concerning customer satisfaction, staff development, and associate performance and satisfaction. The Supervisor is responsible for the daily operations of a Nursing department on a 24-hour basis. The Supervisor collaborates with other clinical and ancillary departments to meet organizational and department-specific Quality and Safety Measures, Community Values, Business Literacy, and Service Excellence goals. CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Implementing and monitoring programs and practices for the delivery of safe and efficient quality nursing care for patients and their families. Ensuring consistent application of nursing services policies and standards throughout the organization. Monitoring patient outcomes and quality and effectiveness of nursing care. Overseeing the performance of teams; identifying and addressing staff training and development needs. Standard I. Human Resources Management Evaluates and specifies the critical resources required to accomplish the team's objectives. Initiates requests for required resources based on staff competency with patient acuity. Allocates team resources responsibly and equitably within the scope of labor laws. Discovers opportunities to improve resource utilization. Implements changes in role consistent with scope of practice. Anticipates and plans for admission/discharge/transfer needs to facilitate patient flow. Resolves conflicts in a wide variety of situations, such as workload or resource allocation, patient and family concerns, patient through-put and capacity needs, associate engagement challenges, etc. Adjusts management and personal style to fit the needs of different people and different situations. Explores motivational factors and tailor's motivational efforts to individual needs and situations for the department. Conducts evaluations on personnel performance at the workplace and recommends improvement plans. Coaches others on operating personnel management systems and their processes. Manages day-to-day labor needs by maintaining optimum staffing levels. Standard II. Relationship Management and Influencing Behaviors Applies principles of crisis management to identify issues that require immediate attention, handle situations as necessary, and manage conflict. Mentors and coach's staff. Encourages participation in professional organization. Embraces principles of self-awareness. Fosters a healthy work environment and encourages stress management. Promotes Diversity and team dynamics and understands the components of cultural competence as they apply to the workforce. Capitalizes on differences and maintains an environment of fairness to foster highly effective work groups. Standard III. Performance Improvement/Safe Practice/Quality Care/Regulations Assesses customer and patient satisfaction while developing and implementing strategies to address satisfaction issues. Provides direct service to internal or external customers and facilitates the resolution of customer problems, issues, or concerns. Monitors and promotes workplace safety requirements resulting in positive patient outcomes. Supports nursing research and quality improvement activities. Provides evidence-based nursing care. Promotes and communicates patient information effectively across the continuum of care. Standard IV. Leadership Serves as a leader of patient care. Utilizes an appropriate style of leadership: autocratic, democratic, laissez-faire/free rein, etc. Demonstrates leadership qualities: intelligence, influence, determination, integrity, confidence. Manages own behaviors during interactions, such as feedback giving, to shape workplace events. Utilizes positive reinforcement to motivate and attain desired behaviors; increases productivity. Clinical Performance Improvement Shares experiences with process performance improvements across multiple areas. Recognizes recurring and difficult problems and explores new or innovative solutions. Leverages technology to facilitate the sharing of clinical performance or outcomes data. Creates mechanism for ensuring quality and performance measures are understood and valued by nursing staff. Implements and supports improvement initiatives at the unit level. Clinical Policies and Standards Monitors different types of clinical practice to ensure compliance with standards and their impact on the organization. Informs others on advanced clinical standards and policies across medical specialties. Collaborates with other functions in establishing and documenting joint standards. Participates in the development of clinical policies and practices. Healthcare Policy and Ethics Compliance Shares experiences with addressing diverse problems in healthcare policy compliance. Demonstrates best practices for dealing with complex compliance or non-compliance situations. Guides others in making correct decisions when faced with ethical dilemmas. Supports and coaches on mechanisms that encourage attention to compliance issues, all clinical activities. Healthcare Regulatory Environment Implements programs as needed to comply with diverse healthcare laws or regulations. Monitors regulatory compliance of all healthcare practices in preparation for external audits to ensure no violations. Job Requirements: Education/Skills Bachelor of Science Degree in Nursing required for Magnet facilities, otherwise preferred. Experience 2 years of clinical patient care experience in a relevant setting. Previous Lead or Supervisor experience overseeing work of assigned units, preferred. Previous healthcare management experience preferred. Licenses, Registrations, or Certifications BLS required. RN License in state of employment or compact. Work Schedule: Varies Work Type: Full Time EEO is the law - click below for more information: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at .

DescriptionSummary: The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Applies demonstrated clinical competency and judgment in order to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria in order to determine the appropriate level of care. Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services. Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and clinical appropriateness recommendations. Coordinate and facilitate correct identification of patient status. Analyze the quality and comprehensiveness of documentation and collaborate with the physician and treatment team to obtain documentation needed to support the level of care. Facilitates joint decision-making with the interdisciplinary team regarding any changes in the patient status and/or negative outcomes in patient responses. Demonstrates, maintains, and applies current knowledge of regulatory requirements relative to the work process in order to ensure compliance, i. e. IMM, Code 44. Demonstrate adherence to the CORE values of CHRISTUS. Utilize independent scope of practice to identify, evaluate and provide utilization review services for patients and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards. Take appropriate follow-up action when established criteria for utilization of services are not met. Proactively refer cases to the physician advisor for medical necessity reviews, peer-to-peer reviews, and denial avoidance. Effectively collaborate with the Interdisciplinary team including the Physician Advisor for secondary reviews. Proactively review patients at the point of entry, prior to admission, to determine the medical necessity of a requested hospitalization and the appropriate level of care or placement for the patient. Review surgery schedule to ensure planned surgeries are ordered in the appropriate status and that necessary authorization has been obtained as required by the payor or regulatory guidance (i. e., CMS Inpatient Only List, Payor Prior Authorization matrix, etc.) Regularly review patients who are in the hospital in Observation status to determine if the patient is appropriate for discharge or if conversion to inpatient status is appropriate. Proactively identify and resolve issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials. Maintain consistent communication and exchange of information with payors as per payor or regulatory requirements to coordinate certification of hospital services. Coordinate and facilitate patient care progression throughout the continuum and communicate and document to support medical necessity at each level of care. Evaluate care administered by the interdisciplinary health care team and advocate for standards of practice. Analyze assessment data to identify potential problems and formulate goals/outcomes. Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA) designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI). Attend scheduled department staff meetings and/or interdepartmental meetings as appropriate. Possesses and demonstrates technology literacy and the ability to work in multiple technology systems. Act as a catalyst for change in the organization; respond to change with flexibility and adaptability; demonstrate the ability to work together for change. Translate strategies into action steps; monitor progress and achieve results. Demonstrate the confidence, drive, and ability to face and overcome challenges and obstacles to achieve organizational goals. Demonstrate competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of patients served by the department. Possess negotiating skills that support the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payers. Excellent verbal and written communication skills, knowledge of clinical protocol, normative data, and health benefit plans, particularly coverage and limitation clauses. Must adjust to frequently changing workloads and frequent interruptions. May be asked to work overtime or take calls. May be asked to travel to other facilities to assist as needed. Actively participates in Multidisciplinary/Patient Care Progression Rounds. Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director. Documents in the medical record per regulatory and department guidelines. May be asked to assist with special projects. May serve as a preceptor or orienter to new associates. Assumes responsibility for professional growth and development. Familiarity with criteria sets including InterQual and MCG preferred. Must have excellent verbal and written communication and ability to interact with diverse populations. Must have critical and analytical thinking skills. Must have demonstrated clinical competency. Must have the ability to Multitask and to function in a stressful and fast-paced environment. Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement. Must have an understanding of pre-acute and post-acute levels of care and community resources. Must have the ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families. Must have an understanding of internal and external resources and knowledge of available community resources. Other duties as assigned. Job Requirements: Education/Skills Graduate of an accredited School of Nursing OR demonstrated success in the Utilization Management Nurse I role for at least five years at CHRISTUS Health on top of required experience in lieu of education required. Experience Two or more years of clinical experience with at least one year in the acute care setting OR demonstrated success as Utilization Management Nurse I role at CHRISTUS Health required. Licenses, Registrations, or Certifications RN License in state of employment or compact required. LPN or LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health. Certification in Case Management preferred. BLS preferred. Work Schedule: Varies Work Type: Full Time EEO is the law - click below for more information: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at .