RN - ProMedica Provider Services - Utilization Management
About The Position
As a Utilization Management RN, you look to maximize the quality and cost-efficiency of health care services at ProMedica. You will complete reviews for admissions and transfers and apply payer rules to obtain authorizations. You will work with physicians, nurses, and other members of the health care team to effectively allocate resources to ensure appropriate care. You will review cases and look for opportunities to improve hospital service utilization. The above summary is intended to describe the general nature and level of work performed by the positions. It should not be considered exhaustive.
Requirements
- Graduate of approved NLN accredited School of Nursing
- Minimum of 3 years acute care nursing experience
- Current RN licensed in the state of hire
Nice To Haves
- Bachelor’s degree
- Knowledge of insurance guidelines and federal, state, and local regulations.
- Experience with UR/UM in hospital acute care setting.
- Previous experience with case management, utilization review, and InterQual criteria
Responsibilities
- Complete reviews for admissions and transfers
- Apply payer rules to obtain authorizations
- Work with physicians, nurses, and other members of the health care team to effectively allocate resources to ensure appropriate care
- Review cases and look for opportunities to improve hospital service utilization
Benefits
- We offer a competitive benefits package with coverage effective day one of employment which includes dental, vision, company paid life insurance, paid time off, a 401k retirement plan, an employee assistance program and other voluntary coverage options and employee discounts.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
