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Utilization Review /Performance Improvement - Licensed Practical Nurse

We are seeking applicants for Utilization Review/Performance Improvement Licensed Practical Nurse to work part-time (32 hours per week - benefit eligible) for the new State Hospital West (SHW) located in Nampa. SHW is a 16-bed Adolescent Psychiatric Treatment Hospital (for adolescents between 11 and 18 years old) nestled between Ridgecrest and Centennial golf courses on a picturesque piece of state property along the Nampa Interstate 84 corridor. SHW provides psychiatric inpatient treatment care for Idaho's adolescent citizens with the most serious and persistent mental illnesses. The hospital works in partnership with families and communities to enable clients to return to community living and will be accredited by The Joint Commission on Accreditation of Health Care Organizations and certified by the Center for Medicare and Medicaid Services. 

This position offers the opportunity to work with an excellent team and help establish our brand-new facility. Idaho Department of Health and Welfare is seeking individuals who are driven to make an impact to our patients’ lives. If you are someone who wants to make a difference, share in growth and development, and know at the end of the day you have made a positive impact, then our Nursing position might be for you! 
 
BEST RETIREMENT AVAILABLE IN THE NATION

We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit. 
 
EXCELLENT BENEFITS
  • excellent medical, dental and vision insurance - (full-time/30+ hours per week) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental 
  • generous vacation and sick leave accrual beginning as soon as you start 
  • 11 paid holidays a year 
  • paid parental leave
  • multiple savings plans, optional 401K, and optional 457
  • basic life insurance for employee and family 
  • employee covered at one times annual salary
  • spouse covered at $10,000
  • child covered at $5,000
  • wellness programs 
  • ongoing training opportunities 
  • an opportunity for student loan forgiveness  
  • and more!

 General Information: 
  • This position will be working under the direction of the Performance Improvement and Accreditation Director 
  • This position also requires applicants to become certified in CPR and Nonviolent Crisis Intervention.

The Idaho Department of Health & Welfare is a drug-free workplace. Any applicant offered employment in this position at the Idaho Department of Health & Welfare, will be required to pass a pre-employment drug test. Applicants will be required to pass a background investigation after a conditional offer of employment.

If you have previously applied for Licensed Practical Nurse and wish to be considered for the current vacancy, you must reapply under this announcement. Previous scores will not be used.

Example of Duties
RULES, POLICIES and PROCEDURES 

  • Performs admission certification review, and concurrent/retrospective an evaluation of patient care needs to determine level of services required, appropriateness of continued stay. Sends copies of utilization review activities to the Department of Health and Welfare and to Medicaid. Processes Appeals of Denial and ensures when indicated that medical records are sent to Managed Care Agencies. Reviews medical records in the event of denied coverage or benefits and notifies the attending physician of denials and schedules retro-reviews and physician to physician reviews as needed.
  • Reports over-utilization, under-utilization, and inefficient scheduling of resources to appropriate Hospital officials.
  • Recommends policy and systems changes that encourage the consistent provision of high-quality patient care and continual improvement in the utilization of patient care services.
  • Works with the treatment team with External Professional Review Organizations for claims, approval authority, review of care, and case management coordination for third party reimbursement decisions. Maximizes the Hospital’s potential for secured payment from third party payers.
  • Skills in performing needs assessments, developing training objectives, designing, and developing coursework and evaluating the training; presenting training to adult groups in structured learning situations; using a variety of training methods. Additionally, incumbent will need to possess necessary computer skills to develop computer-based training.
  • Working alongside the SHW team to ensure compliance with Joint Commission, CMS, and State Licensure standards. Assist supervisors with staff development plans and orientation and training.

 TRAINING
 
  • Help in developing, disseminating and monitoring training materials and plans for SHW staff including New Employee Orientation and all staff annual training.
  • Responsible to plan and coordinate the hospital-wide annual review in conjunction with the Executive Leadership Team. Ensure staff are scheduled and notified of required attendance.

OUTCOME MONITORING AND CONTINUOUS IMPROVEMENT 

  • Participates in review of operational findings and works cooperatively with regional and central office staff to suggest, support, and implement strategies.

Minimum Qualifications
You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. Please make sure your resume supports your answers. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.

  • Licensed as a Licensed Practical Nurse by the state of Idaho or state licensure as a Practical Nurse pursuant to the Nurse Licensure Compact, Idaho Code 54-1418, in one of the following compact states: Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin or Wyoming.

Supplemental Information

EXTRA CREDIT:  
 
Below are questions for extra credit. They are not required, however, having the minimum qualifications and the education and/or experience below will increase your score. 
  1. Some experience with insurance and medical billing. Gained by at least one year of previous work experience in this area.
  2. Some experience with utilization review. Gained by at least one year of previous work experience in this area.
  3. Working knowledge of Microsoft Office Products (Word, Excel, Teams, PowerPoint). Gained by at least two years of experience working with Microsoft Office Products.
  4. Experience interpreting and reporting out basic data. Gained by at least two years of previous work experience in this area.

EEO/AA/Veteran