The Manager, Quality Assurance/Utilization Review is accountable for managing the Quality Assurance and Utilization Review functions of the hospital in accordance with legislative and accrediting agencies guidelines.

Designs and maintains an ongoing Quality Assurance Program to monitor and evaluate the quality and appropriateness of patient care.

         Assures that each department has a written plan for the Quality Assurance Program and that these plans are current.

Serves as chairperson and staffs the Quality Assurance Committee to identify problems in the Quality Assurance Program and makes recommendations to the Administrator to assure that department heads follow through to correct these problems.

Reviews the Quality Assurance Program and makes recommendations to the Administrator on how to improve the quality of patient care.

Oversees and maintains a program for patient record review and assure that these records are complete, and proper codes recorded to justify the admission length of stay, the appropriateness and cost effectiveness of care, and the optimization of reimbursement.

 Issues in-house denials for extended length of stays.

 Serves on various hospital committees as required.          

 Keeps abreast of current Quality Assurance and Utilization Review standards and regulations.

 Interviews, selects, evaluates and terminates personnel or recommend such action as necessary.

           Formulates and prepares budgets, work reports and other administrative guides.

  Performs other related duties as assigned.

 EDUCATION, TRAINING AND EXPERIENCE:

 Registered Nurse (licensed in state of employment) from an accredited School of Nursing and a minimum of two (2) years nursing experience.  Also, minimum of two (2) years experience in a managerial position in a clinical setting preferred.

 Demonstrated ability to analyze, synthesize, report and manage patient care information typically obtained through previous experience in quality assurance and/or utilization review.  Demonstrated written and verbal communications skills.

POSITION PHYSICAL REQUIREMENTS:

Must possess the physical ability needed to exert 20 to 50 pounds of force occasionally; and/or 10 to 25 pounds of force frequently; and/or greater than negligible up to 10 pounds of force constantly to move objects.  Physical Demand requirements are in excess of those for light work.

SPECIFIC ACCOUNTABILITIES:

 Responsible for assuring an ongoing Quality Assurance Program designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, pursue opportunities to improve patient care, and resolve identified problems.

Responsible for monitoring and evaluating patient care information collected to evaluate the activities involving admissions and continued stay reviews to detect any problems, trends, etc., in utilization of hospital facilities, maximize reimbursement and to assure compliance with federal and state regulations and accrediting agencies.

Responsible for the total management and supervision of the QA and UR departments and its employees.