Occ. Code 5516000
Rehabilitation Hospital Utilization Manager, M-2
New York State Department of Civil Service
BRIEF DESCRIPTION OF CLASS
The one position in this class manages, directs, and coordinates non-medical professional services such as dietary, speech therapy, physical therapy, case management, vocational rehabilitation, recreation therapy, occupational therapy, patient library, admissions and patient education. The incumbent of this position assists in the planning, development, review and evaluation of policies, procedures and protocols for the enhancement of patient care and treatment, and of clinical research.
This position is classified at the Department of Healths Helen Hayes Hospital. All incumbents at Helen Hayes Hospital perform various duties and functions in conjunction with the overall operation of the hospital.
Rehabilitation Hospital Utilization Manager: managerial; oversees the operations of non-clinical departments, such as Social Work, Case Management, Utilization Review, and Admissions and Referral; and monitors and evaluates the expenditures of Case Management, Admissions, and Utilization Review Department cost centers from authorized appropriations.
Oversees the operation of Social Work/Case Management, Utilization Review and Admissions/Referral departments.
- Reviews and updates policies and procedures to assure their relevance to the needs of the patients and to the mission and goals of the hospital.
- Ensures that competency of staff is assessed and maintained on an on-going basis.
- Ensures that staff, patients, visitors, referral sources and payor representatives are treated courteously, fairly, and with dignity.
- Ensures that Case Management and Admissions Department Quality Improvement processes are appropriate by reviewing indicators, thresholds, outcomes and action plans.
Participates in the Utilization Management Departments budget request, prepares annual and periodic reports and other documents and monitors/evaluates the expenditures of Case Management, Admissions and Utilization Review Departments cost centers from authorized appropriations.
- Ensures the availability of staff development opportunities via the provision of appropriate in-service training and the utilization of other educational resources.
- Directs and monitors services of Case Management, Utilization Review and Admission Departments through reporting structures with subordinates and personally ensures resolution of issues/problems relative to the smooth function of the Utilization Management Department as a whole.
- Ensures understanding and implementation of policies established by hospital administration.
- Develops and collaborates with other departments to implement a case management program for the hospital. Evaluates and improves program on a continuing basis.
- Participates in hospital initiatives to increase referrals/admissions including marketing, networking and presentations to Managed Care Organizations.
- Reviews payor denials with Utilization Review Nurse, evaluates appropriateness of appeal and notes trends of denials. Recommends program changes related to admission criteria of length of stay.
Utilizing established/accepted program evaluation tools, analyzes data for trends, anomalies, patterns, areas of specific concern.
- Interprets and creates reports for use by discipline heads/unit chiefs, directors.
- Presents findings from analysis of data to identified committees.
- Reviews and evaluates facility length-of-stay norms on an annual basis.
- Collects and analyzes data for facility-wide performance improvement projects and quality management reporting and monitoring.
- Reviews contracted outside organizations findings (including pre-accreditation surveys) to recommend corrective action.
- Identifies those records which are deficient and follows-up to ensure proper documentation is contained in the patients charts.
Performs periodic review of facilitys Utilization Review Plan.
- Tracks the quantity and type of utilization review screenings completed each month.
- Communicates utilization review findings to appropriate clinical and administrative staff.
- Consults with disciplines and departments regarding the collection and evaluation of practitioner-specific data resulting from various aspects of the utilization review process.
- Educates other facility staff concerning documentation.
- Maintains relevant and accurate information systems and records of all utilization review activities.
- Designs data collection systems for use by discipline heads, unit managers, directors, department heads in accordance facility needs.
- Makes recommendations for improvement of existing data collection systems as appropriate.
- Designs satisfaction survey tools to obtain patient, staff, and family satisfaction information.
- Designs systems to track status of Performance Improvement reports.
Represents the hospital at meetings, conferences and symposia.
Serves as a spokesperson for the non-medical treatment programs and protocols.
Open Competitive: a Masters Degree in a health care field or public health administration, and three years of experience managing departments involving professional, medical or other direct patient care services; or a Bachelors Degree in a health care field or public health administration, and five years of experience managing departments involving professional, medical or other direct patient care services.
NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.