Utilization Management Rep I

Tasks

• Collaborate with other health care professionals and service providers to ensure optimal patient care.

• Provide consultation to other health care providers in areas such as patient discharge, patient care, or clinical procedures.

• Develop or assist others in development of care and treatment plans.

• Develop and maintain departmental policies, procedures, objectives, or patient care standards, based on evidence-based practice guidelines or expert opinion.

• Read current literature, talk with colleagues, or participate in professional organizations or conferences to keep abreast of developments in nursing.

• Evaluate the quality and effectiveness of nursing practice or organizational systems.

• Develop, implement, or evaluate standards of nursing practice in specialty area such as pediatrics, acute care, and geriatrics.

• Design evaluation programs regarding the quality and effectiveness of nursing practice or organizational systems.

• Plan, evaluate, or modify treatment programs, based on information gathered by observing and interviewing patients or by analyzing patient records.

• Direct or supervise nursing care staff in the provision of patient therapy.

• Instruct nursing staff in areas such as the assessment, development, implementation and evaluation of disability, illness, management, technology, or resources.

• Monitor or evaluate medical conditions of patients in collaboration with other health care professionals.

• Design patient education programs that include information required to make informed health care and treatment decisions.

• Provide specialized direct and indirect care to inpatients and outpatients within a designated specialty, such as obstetrics, neurology, oncology, or neonatal care.

• Make clinical recommendations to physicians, other health care providers, insurance companies, patients, or health care organizations.

• Maintain departmental policies, procedures, objectives, or infection control standards.

• Present clients with information required to make informed health care and treatment decisions.

• Perform discharge planning for patients.

• Identify training needs or conduct training sessions for nursing students or medical staff.

• Participate in clinical research projects, such as by reviewing protocols, reviewing patient records, monitoring compliance, and meeting with regulatory authorities.

• Lead nursing department implementation of, or compliance with, regulatory or accreditation processes.

• Observe, interview, and assess patients to identify care needs.

• Write nursing orders.

• Chair nursing departments or committees.

• Develop nursing service philosophies, goals, policies, priorities, or procedures.

• Coordinate or conduct educational programs or in-service training sessions on topics such as clinical procedures.

• Teach patient education programs that include information required to make informed health care and treatment decisions.

• Prepare reports to document patients' care activities.

• Provide direct care by performing comprehensive health assessments, developing differential diagnoses, conducting specialized tests, or prescribing medications or treatments.

Skills

• Reading Comprehension - Understanding written sentences and paragraphs in work related documents.

• Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

• Writing - Communicating effectively in writing as appropriate for the needs of the audience.

• Speaking - Talking to others to convey information effectively.

• Science - Using scientific rules and methods to solve problems.

• Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

• Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.

• Learning Strategies - Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.

• Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.

• Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.

• Coordination - Adjusting actions in relation to others' actions.

• Persuasion - Persuading others to change their minds or behavior.

• Negotiation - Bringing others together and trying to reconcile differences.

• Instructing - Teaching others how to do something.

• Service Orientation - Actively looking for ways to help people.

• Complex Problem Solving - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

• Operations Analysis - Analyzing needs and product requirements to create a design.

• Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.

• Systems Analysis - Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.

• Systems Evaluation - Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system.

• Time Management - Managing one's own time and the time of others.

• Management of Personnel Resources - Motivating, developing, and directing people as they work, identifying the best people for the job.

Knowledge

• Administration and Management - Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

• Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

• Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

• Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

• Biology - Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.

• Psychology - Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.

• Sociology and Anthropology - Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.

• Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.

• Therapy and Counseling - Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.

• Education and Training - Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.

• English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

• Philosophy and Theology - Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.