NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.
About the Job
Location: Pender Memorial Hospital
Department: Pender Memorial Hospital
Full Time Equivalent: FTE: 1.000000
Work Type: 64 to 80 Hours Pay Period
Work Schedule: 8HR DAY - Most of shift btwn 7A-3P
Exempt from Overtime: Exempt: Yes
What You'll Do
The Manager of Outcomes and Nursing Supervision is a Registered Nurse reporting to the CNE/COO to achieve improvements in patient outcomes, utilization management, discharge planning and after-hours supervisory coverage. This is a multifaceted role, incorporating expertise in clinical practice, utilization review, and case management methodologies to achieve measurable improvements in the five pillars: service, people, quality, finance, and growth. The Manager of Outcomes and Nursing Supervision is responsible for the Patient Care Supervisors, RN Case Managers, Social Workers, Discharge Facilitator and Admission Coordinators. The Manager of Outcomes and Nursing Supervision is self-directed and acts as an effective leader, catalyst for change, and role model for quality nursing practice.
- Effectively facilitates assigned clinical outcome initiatives in collaboration with medical and hospital staff to redesign operations and clinical practice in support of the hospital’s strategic initiatives, goals and objectives (identifying opportunities for improved outcomes, reduced cost, improved LOS, and best practice utilization of resources).
- Coordinates the development of the annual Utilization Review Plan.
- Oversees the Patient Care Supervisors in their role of whole-house management after-hours when most leaders are off-site. Keeps this staff informed of the vast array of changes and updates that can affect their role.
- Collaborates with the organization-wide program Quality Management System as led by the Manager of Pharmacy & Quality.
- Utilizes clinical data bases and national benchmarks to identify opportunities for improved outcomes, reduced cost, improved LOS, and best practice utilization of resources.
- Serves as Liaison to NHRMC Case Management to facilitate referrals and transfers of post-acute patients to Pender Swing & SNF.
- Coordinates activities of peer review process including case review against defined performance measures for referral through the peer review process.
- Provides support for physician OPPE/FPPE profiles.
- Supports activities necessary to facilitate success with organizational priorities such as DNV, CMS and other accreditation initiatives.
- Serves as expert resource and consultant related to control of utilization of outpatient in bed, observation and inpatient hospital services that include certification of medical necessity based on plan of care and utilization review. Applies MCG guidelines criteria to evaluate denied claims for appealability.
- Coordinates with Patient Financial Services on all aspects of denial management. Assists with appeals on all appropriate cases of the clinical denials and tracks avoidable days.
- Liaison to Health Information Management and Patient Financial Services staff regarding medical record documentation for level of care, coding, and correct billing status, including release of bills when suppressed for pending appeal.
- Oversees the hospital notice of non-coverage process which includes responsibility for notification of all appropriate parties when letters are issued.
- Oversees the certification compliance for the Swing and SNF population. Also monitors and oversees the issuance of NOMNC (Notification of Medicare non-Coverage) for the Swing and SNF populations as applicable.
- Oversees compliance with IMM (Important Message from Medicare) and MOON (Medicare Outpatient Observation Notice) processes for One West acute patient population
- Stays abreast of changes in regulatory requirements for utilization review and discharge planning.
- Demonstrates proficiency in all utilization management software and hospital information systems used to obtain clinical information on patients.
* Registered Nurse
* Bachelor of Nursing
Education: Bachelor’s degree required; Master’s degree in nursing, business, or related field preferred.
Licensure/Certification: RN required; CPHQ certification and Utilization Management certification preferred
Experience: Minimum of 5 years experience as RN with 3 years experience in quality, peer review, regulatory compliance, etc. preferred
Other – Hours of Work: Flexible 8-hour shifts (5 per week Sun-Sat) to meet needs of hospital.
Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.
This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.
- Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve.
- Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek.
- Forbes America’s Best Large Employers 2018 and 2019- Link
- Becker’s 150 Top Places to Work in Healthcare- Link
- Healthgrades Outstanding Patient Experience
Consider a career at NHRMC and become part of this award winning team!