Utilization Review/Case Management Clinical Nurse (Regular, Full-time)

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Wind River Family and Community Healthcare
August 28, 2018
Open Until Filled

Hours: Monday-Friday, 8:00 a.m.- 4:45 p.m., with some variations

Summary: Wind River Family & Community Health Care is seeking applicants for the position of Utilization Review/Case Management Clinical Nurse, (UR/CM). Wind River Family & Community Health Care provides ambulatory health care for the service population of the Wind River Reservation. The UR/CM serves as a member of the clinical and administrative team in the outpatient clinic at the Wind River Family & Community Health Care Center, located in Arapahoe, Wyoming, and will fall under the supervision of the CEO.
The candidates’ primary responsibilities are to describe WRFCHC standards, requirements, structures and activities necessary to ensure the efficient and effective use of clinical care resources. The successful candidate will ensure that the WRFCHC clients receive services that are medically necessary, appropriate as to type, frequency, intensity and duration and is consistent with their needs and desires. The candidate will ensure that all WRFCHC clients with comparable health care needs receive comparable services as to type, frequency, intensity and duration.
The UR/CM is responsible for service authorization decisions and their oversight. The candidate is also responsible for the development, implementation and updating of service eligibility entry, continuing stay and discharge criteria.
Working in conjunction with the appropriate professional staff, the UR/CM will review that the procedures and clinical decisions provided to a specific consumer at a given time are appropriate, medically necessary and cost effective. In addition they will analyze the patterns of service authorization decisions and service usage in order to determine the means for increasing the value of services provided, (i.e. minimize cost and maximize effectiveness).
The successful candidate will have the ability to analyze trends in patient care and referrals, develop customized reports according to specific criteria and present such in an organized, professional and cohesive manner.The UR/CM will constantly evaluate high cost services, highly utilized services, services associated with a high number of consumer grievances and appeals, services for which there are large differences in cost per case and/or cost per unit among individual affiliates, and services which are over and/or underutilized. The UR/CM will ensure the implementation of improved planning/corrective action as necessary by:
Analyzing EHR data, cost per unit or cost per case, average length of stay for a specified service, client and provider satisfaction, studies of over/under utilization, studies of inpatient admissions per capita, studies of utilization of alternatives to high cost care, and other duties as required.
This position will require the ability to effectively supervise and direct other employees of the UR/CM team. The candidate will also be responsible for managing and overseeing all activities related to AAAHC accreditation process for WRFCHC. They will also be responsible for discharge planning from hospitals and other health care institutions. Other duties as needed.

Knowledge Required:
The successful candidate will have excellent analytical ability, preferably advanced computer/spreadsheet skills, and a working knowledge of medical terminology. The ability to statistically analyze various information using changing varying parameters will be necessary to be proficient in this position.
A minimum of an AS in Nursing with a minimum of 4 years experience in progressively more responsible assignments, with a familiarity of the referral process is acceptable, with a BSN preferred.

Personal Attributes:
The incumbent must maintain strict confidentiality and high ethical standards in performing the position. The incumbent needs to be respectful, possess cultural awareness and sensitivity, be flexible, and demonstrate sound work ethics.

How to Apply:
Complete a Northern Arapaho Tribal application form and submit it to the Northern Arapaho Human Resources program. Applications can be mailed to Northern Arapaho Human Resources, P.O. Box 396, Fort Washakie, WY 82514. Applications can also be hand delivered to Northern Arapaho Human Resources at the Tribal Complex Building, located at 533 Ethete Road, Ethete, Wyoming, or the HR office located at 511 N. 12th E., Riverton, Wy. Indian preference applies.
Application forms and the full job description can be obtained on the Tribe’s website at www.northernarapaho.com.
For more information please call 307-335-3964/3970, or 307-463-4473. Fax Number: 307-335-3596.