Clinical Utilization Specialist RN

4 weeks ago

Toronto, Ontario, Canada HealthEcareers - Client Full time
Job Summary: As a Clinical Utilization Specialist RN with HealthEcareers - Client, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for inpatient hospitalization. You will interact with the family, patient, and other disciplines to coordinate a safe and acceptable discharge plan. You will function as an indirect caregiver, patient advocate, and manage patients in the most cost-effective way without compromising quality. You will transfer stable non-members to planned healthcare facilities. You will be responsible for complying with AB 1203, Post Stabilization notification. You will comply with other duties as described. You must be able to work collaboratively with the multidisciplinary team, multitask, and in a fast-paced environment.

Essential Responsibilities:
  • Plans, develops, assesses, and evaluates care provided to members.
  • Collaborates with physicians, other members of the multidisciplinary healthcare team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use.
  • Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
  • Assesses high-risk patients in need of post-hospital care planning.
  • Develops and coordinates the implementation of a discharge plan to meet patients' identified needs; communicates the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies.
  • Reviews, monitors, evaluates, and coordinates the patients' hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
  • Participates in the Bed Huddles and carries out recommendations congruent with the patients' needs.
  • Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
  • Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient, and non-KFH facilities.
  • Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
  • Refers patients to community resources to meet post-hospital needs.
  • Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
  • Adheres to internal and external regulatory and accreditation requirements and compliance guidelines, including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL.
  • Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
  • Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
  • Per established protocols, reports any incidence of unusual occurrences related to quality, risk, and/or patient safety which are identified during case review or other activities.
  • Reviews, analyzes, and identifies utilization patterns and trends, problems, or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
  • Coordinates, participates, and/or facilitates care planning rounds and patient family conferences as needed.
  • Participates in committees, teams, or other work projects/duties as assigned.
Basic Qualifications:
  • Two (2) years combined RN experience in an acute care setting or case management required.
Additional Requirements:
  • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, discharge planning, or case management.
  • Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
  • Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
  • Demonstrated ability in planning, organizing, conflict resolution, and negotiating skills.
  • Computer literacy skills required.
Preferred Qualifications:
  • Bachelor's degree in nursing or healthcare-related field.

  • Clinical Nurse Specialist

    1 week ago

    Toronto, Ontario, Canada Baycrest Full time

    Job Title:Clinical Nurse SpecialistAbout the Role:Baycrest Health Sciences is a leader in brain health and aging. We are seeking a highly skilled Clinical Nurse Specialist to join our team.Responsibilities:Provide comprehensive, quality client/family-centred health care services from admission through transfers and discharge.Plan, deliver, and evaluate...

  • Clinical Care Specialist

    2 weeks ago

    Toronto, Ontario, Canada Bridle Post Dental Full time

    Part-time opportunity available at Bridle Post Dental as a clinical care specialist. Main Responsibilities:As a clinical care specialist, you will be responsible for administering medications as directed by the oral surgeon, monitoring patient conditions, and assisting with discharge planning. You will also be required to start IVs and assess patient vital...

  • Healthcare Navigator with RN Expertise

    5 days ago

    Toronto, Ontario, Canada HealthCare Talent Full time

    About the RoleWe are seeking a skilled Care Manager, RN to join our team at HealthCare Talent. This is a fantastic opportunity for an experienced healthcare professional to utilize their clinical expertise and interpersonal skills to make a positive impact on the lives of our members.

  • Clinical Research Document Specialist

    2 weeks ago

    Toronto, Ontario, Canada Everest Clinical Research Services Inc Full time

    Job DescriptionJob Title: Clinical Research Document SpecialistCompany: Everest Clinical Research Services IncLocation: Remote or Toronto/Markham, Ontario, CanadaJob Type: Full-timeAbout Us:Everest Clinical Research Services Inc is a leading contract research organization (CRO) providing clinical research services to pharmaceutical, biotechnology, and...

  • Ambulatory Medical Specialty Clinics Nurse

    4 weeks ago

    Toronto, Ontario, Canada Baycrest Full time

    Job Summary:Baycrest offers a comprehensive range of outpatient clinics and specialist services, all conveniently located on one campus. This position provides nursing care in the Ambulatory Medical Specialty Clinics, working closely with physician and nurse-led specialist teams.Responsibilities:Deliver high-quality, client-centered care, acting as a...

  • Clinical Nurse Specialist

    4 weeks ago

    Toronto, Ontario, Canada destinationone Consulting Full time

    At destinationone Consulting, we are seeking a highly skilled Clinical Nurse Specialist to join our team. As a Clinical Nurse Specialist, you will serve as an expert clinician, educator, and consultant within a specialized area of nursing practice. Your role will be essential in enhancing patient care, guiding nursing practices, and improving healthcare...

  • Clinical Technology Specialist

    4 weeks ago

    Toronto, Ontario, Canada PSI CRO Full time

    Job DescriptionAs a Clinical Technology Specialist at PSI CRO, you will provide technical support and expertise to clinical sites related to technology. Your responsibilities will include assisting in the design and implementation of study-related forms, guidelines, and manuals related to technologies, coordinating data collection related to technologies,...

  • Clinical Solutions Specialist

    4 days ago

    Toronto, Ontario, Canada Innomar Strategies Full time

    Clinical Solutions SpecialistWe are seeking a highly skilled Clinical Solutions Specialist to join our team at Innomar Strategies. This is a full-time opportunity that requires strong communication and interpersonal skills, as well as the ability to manage multiple tasks and priorities.About the RoleAs a Clinical Solutions Specialist, you will be responsible...

  • Healthcare Professional

    4 weeks ago

    Toronto, Ontario, Canada HealthCare Talent Full time

    Care Manager, RN Job SummaryHealthCare Talent is seeking a skilled Care Manager, RN to join our team. As a Care Manager, RN, you will work effectively with the Integrated Care Team to provide high-quality, effective care management to members.Key Responsibilities:Work with a caseload of members with medical needs.Utilize brief medical interventions to...

  • Healthcare Professional

    4 weeks ago

    Toronto, Ontario, Canada HealthCare Talent Full time

    Care Manager, RN Job SummaryHealthCare Talent is seeking a skilled Care Manager, RN to join our team. As a Care Manager, RN, you will work effectively with the Integrated Care Team to provide high-quality care management to members. This role is responsible for working collaboratively with members of the Integrated Care Team, members and families, and other...

  • Clinical Operations Manager RN

    4 weeks ago

    Toronto, Ontario, Canada Glen Rouge Community Full time

    About the Role:Glen Rouge Community is seeking a dedicated and compassionate Associate Director of Care RN to join our team. As a key member of our Long Term Care team, you will be responsible for overseeing clinical operations, leading clinical staff, and ensuring regulatory compliance to enhance the health, safety, and well-being of our residents.Key...

  • Clinical Nurse Specialist

    4 weeks ago

    Toronto, Ontario, Canada destinationone Consulting Full time

    At destinationone Consulting, we are seeking a highly skilled Clinical Nurse Specialist to join our team. As a CNS, you will serve as an expert clinician, educator, and consultant within a specialized area of nursing practice. Your role will be essential in enhancing patient care, guiding nursing practices, and improving healthcare outcomes through...

  • Clinical Nurse Specialist

    4 weeks ago

    Toronto, Ontario, Canada destinationone Consulting Full time

    At destinationone Consulting, we specialize in recruitment across diverse sectors, including Healthcare, HealthTech, Government, Municipalities, NonProfits, Legal, and Public Accounting. We are committed to building a comprehensive database of opportunities in these fields. By applying, you ensure our recruiters can quickly match you with suitable roles when...

  • Clinical Care Specialist

    4 weeks ago

    Toronto, Ontario, Canada Baycrest Full time

    About the Role:Baycrest is seeking a skilled Registered Practical Nurse to join our team. As a Clinical Care Specialist, you will provide high-quality client-centered care, working collaboratively with our interdisciplinary care team to meet the personal, activation, recreation, and spiritual needs of our clients.Key Responsibilities:Plan, deliver, and...

  • Clinical Nurse Specialist

    4 weeks ago

    Toronto, Ontario, Canada destinationone Consulting Full time

    Job SummaryDestinationone Consulting is seeking a highly skilled Clinical Nurse Specialist to join our team. As a CNS, you will serve as an expert clinician, educator, and consultant within a specialized area of nursing practice.Key Responsibilities:Provide advanced nursing care and expertise in your specialty area, assessing and diagnosing patient...

  • Healthcare Professional

    4 weeks ago

    Toronto, Ontario, Canada HealthCare Talent Full time

    Care Manager, RN Job DescriptionAt HealthCare Talent, we are seeking a highly skilled Care Manager, RN to join our team. As a Care Manager, RN, you will be responsible for working effectively with the Integrated Care Team to provide high-quality, effective care management to members.Key Responsibilities:Work with a caseload of members with medical...

  • Clinical Care Specialist

    4 weeks ago

    Toronto, Ontario, Canada Baycrest Full time

    Job Summary:Baycrest is seeking a skilled Registered Practical Nurse to join our team. As a Clinical Care Specialist, you will provide high-quality client-centered care to our residents in a Long-Term Care setting.Key Responsibilities:Collaborate with RNs to provide sound clinical knowledge and skills, acting as a clinical expert and resource.Plan, deliver,...

  • Strategic Communications Specialist for Medical Clinic Programs

    1 week ago

    Toronto, Ontario, Canada ADVANCE ENDOSCOPY AND SPECIALIST CENTRE Full time

    Job Description:We are seeking a highly skilled Strategic Communications Specialist to join our team at Advance Endoscopy and Specialist Centre. This role will play a crucial part in implementing effective communication strategies for our medical clinic programs.About the Role:Evaluate and develop public written materials for our clinicsProduce educational...

  • Clinical Pharmacist Specialist

    4 weeks ago

    Toronto, Ontario, Canada destinationone Consulting Full time

    Job Title: Clinical Pharmacist SpecialistDestinationone Consulting is seeking a highly skilled Clinical Pharmacist Specialist to join our team. As a Clinical Pharmacist Specialist, you will play a critical role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient outcomes.Key...

  • Clinical Trials IWRS Data Management Specialist

    4 days ago

    Toronto, Ontario, Canada Everest Clinical Research Services Inc Full time

    Everest Clinical Research Services IncWe are a full-service contract research organization (CRO) dedicated to providing high-quality clinical research services to the pharmaceutical, biotechnology, and medical device industries worldwide.Job Description:As a Clinical Trials IWRS Data Management Specialist, you will be responsible for ensuring the accuracy...