Clinical Utilization Specialist, Decision Support

Every patients journey matters and as a Clinical Utilization Specialist (CUS) at Hennick Bridgepoint Hospital you play a key role in making those journeys smoother. This position is ideal for someone who understands how patient flow and team coordination come together to place patients where their care needs will be best met. You will gain a unique perspective across Sinai Health and the health care system with exposure to specialty programs such as palliative care dialysis and transitional care while building expertise that strengthens your career in healthcare operations.

Is this you
You make communications clear and easy to understand especially when capacity this role that means attending daily bed meetings with hospital leadership across the organization coordinating with referring partners and sharing admission decisions for our care programs. Acting as the communication hub between sending and receiving units you help ensure everyone works from the same plan and patients experience smooth transitions.

If you are an analytical thinker this role plays to your strengths. As a Clinical Utilization Specialist that means reviewing key data elements in EMR documentation applying eligibility criteria and weighing available resources to determine the best placement for patients. Using this skill and your coding experience ensures that each patients complexity is accurately reflected in abstracted records.

Are you someone who staff can count on to make the right decision Colleagues rely on you as a resource for program knowledge from rehabilitation and complex care to specialty services such as palliative care dialysis and transitional care. Your dependability will shine when working with the Utilization team to remove any barriers effecting timely admissions.

About this team:
The Clinical Utilization team at Hennick Bridgepoint Hospital plays a crucial role in managing patient flow and clinical reporting across the hospital. We work closely with the admitting department clinical units and supporting areas to ensure patients are matched to the right bed at the right time.

Each year our team supports timely transfers into 474 beds across 15 programs and services contributing to approximately 3300 admissions. By connecting care across departments and partners we help ensure that patients receive the appropriate level of care while maintaining smooth hospital operations.

In this role you will:

• Provide expertise in capacity/bed management
• Review patient specific clinical and demographic data and complete abstracts for submission within specified deadlines/targets
• Attend daily bed meeting with the clinical units to ensure communication of upcoming discharges
• Review program/service wait lists (daily) and match patients to available capacity
• Review and communicate decisions for referrals to Hennick Bridgepoint Hospital programs in electronic referral system (RM&R)
• Analyse service specific data sets for external partners (Dialysis reporting metrics Hip fracture GTA rehab network FIM and COPM - Stroke Network)
• Work in bedboard application to match and assign patients to units/bed
• Communicate with clinical teams to ensure right bed is ready for patient on transfer
• Understand and support the clinical implications of admitting discharge and transfers and ensures the efficient and effective completion of tools required to manage patient complexity resource requirements and clinical outcomes
• Work with Patient Care Managers Directors and other clinical leadership staff to provide advice support guidance and direction with respect to issues of clinical utilization patient complexity and workload
• Identify communicate and implement processes to address issues of clinical utilization patient complexity and workload
• Perform other duties consistent with the job classification as required

• Bachelors degree in Nursing or Allied Health Discipline or related field
• 5 years of experience in a clinical setting

• Bachelors degree with a specialization in nursing
• Expertise in capacity/bed management
• Previous experience with Meditech Winrecs/Med2020

• Advanced knowledge base of MDS IRRS InterRai LTCF Assessments RUGIII Patient Classification Systems NRS WTIS and working knowledge of workload measurement would be an asset
• Knowledge of Wait Times Information System (ALC) and MIS/OHRS guidelines
• Knowledge of hospital processes and their interrelationships
• Advanced level proficiency in Microsoft Office applications including database software applications
• Demonstrated knowledge of continuous quality improvement process cycle including benchmarking and analyzing industry standards
• Demonstrated ability to perform data collection integration analysis and reporting on organization-wide projects assigned
• Demonstrated understanding and supporting the clinical implications of admitting discharge and transfers
• Demonstrated teaching/facilitation skills
• Strong ability to manage multiple projects resources and initiatives in a deadline driven environment
• Excellent analytical and problem solving skills
• Strong ability to demonstrate professionalism integrity diplomacy and tact

Employment at Sinai Health is conditional upon the verification of credentials completion of a health review and demonstrating proof of immunity and vaccination status of vaccine-preventable diseases. All employees and affiliates will follow safe work practices and comply with health and safety policies procedures and training. If you believe you are one of the very few people who may require an exemption from vaccination supporting medical information must be submitted to our Occupational Health department who will review and assess.

Sinai Health is comprised of Mount Sinai Hospital Hennick Bridgepoint Hospital Lunenfeld-Tanenbaum Research Institute and our system partner Circle of Care. We deliver excellent care in hospital community and home focusing on the comprehensive needs of people. Sinai Health discovers and translates scientific breakthroughs pushes boundaries for health solutions and educates future clinical and scientific leaders. Clinical areas of specialization include rehabilitation and complex continuing care surgery and oncology urgent and critical care and womens and infants health. The Lunenfeld-Tanenbaum Research Institute ranks among the top ten biomedical research institutes in the world. Sinai Health is a full affiliate of the University of Toronto.

As an equal opportunity employer who understands that diversity enriches our community and culture we invite applications from all qualified candidates including Indigenous Peoples racialized people disabled people/people with disabilities women and members of 2SLGBTQIA communities. If you require accommodation(s) due to disability at any point during the application and hiring process please contact ext. 7050 or email .