Concurrent Utilization Management Nurse

UCSF•San Francisco, CA

2d•$85 - $115

About The Position

The Concurrent Utilization Management (UM) Nurse is responsible for completing pre-admission, initial, concurrent and/or retrospective reviews of inpatient hospitalization services and for the determination of medical appropriateness and medical necessity for a variety of patient cohorts using evidence-based clinical guidelines and/or nationally recognized criteria. The UM RN will use their clinical findings from their reviews to inform the care team of level of care recommendations, identify continued stay variances, relay and attempt to overcome authorization issues, generate estimated expected dates of discharge, as well as highlight any provider documentation concerns. About UCSF The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world’s leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells. Pride Values UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence – also known as our PRIDE values [https://www.ucsf.edu/about/mission-and-values]. In addition to our PRIDE values, UCSF is committed to equity – both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available here [https://diversity.ucsf.edu/]. Join us to find a rewarding career contributing to improving healthcare worldwide. Equal Employment Opportunity The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. Salary Information The final salary and offer components are are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement. To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html [https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fucnet.universityofcalifornia.edu%2Fcompensation-and-benefits%2Findex.html__%3B!!LQC6Cpwp!uPLWUNVR0rFXMaSxiegp2raBmrA8C98l3-u68X5cON0um3OJMU_XUivT5BcOsGRYxtGPmgcRECZCCPoE3BWZz30_aN1A%24&data=05%7C02%7Ckellestad%40deloitte.com%7C09196a31acf74487ae9208de8b4b632a%7C36da45f1dd2c4d1faf135abe46b99921%7C0%7C0%7C639101353128138525%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=YCGJ3ybBxqEKRAZBHus2KaGkepN2dmG3pACwRBxDLng%3D&reserved=0] The UCSF Health Utilization Management Department is part of the multidisciplinary team of expert clinicians and staff, who continually strive to provide proactive patient centered access to care and resources along the healthcare continuum. This department evaluates the efficiencies, appropriateness and medical necessity of treatments, services, procedures, and facilities provided to patients on a case-by-case basis using identified evidence-based criteria guidelines. This department works closely with patient�s insurers, compliance, admitting, case management and patient financial services to ensure that the organization is reimbursed for the clinically appropriate care provided to our patients.

Requirements

Evidence-based clinical guidelines
Nationally recognized criteria

Responsibilities

Completing pre-admission, initial, concurrent and/or retrospective reviews of inpatient hospitalization services.
Determining the medical appropriateness and medical necessity for a variety of patient cohorts using evidence-based clinical guidelines and/or nationally recognized criteria.
Using clinical findings from reviews to inform the care team of level of care recommendations.
Identifying continued stay variances.
Relaying and attempting to overcome authorization issues.
Generating estimated expected dates of discharge.
Highlighting any provider documentation concerns.