Utilization Management Nurse I

Olympic Medical Center•Port Angeles, WA

1d•$40 - $68

About The Position

Under general direction using established level of care criteria/guidelines, the Utilization Management RN I monitors the appropriateness of hospital admissions and stays. Monitoring includes review of admission status, medical necessity (severity of illness and intensity of service), and continued stay to comply with government and insurance company reimbursement policies. The Utilization Management RN I consults with physician/supervisor as necessary to resolve deviations from established criteria, and obtains documentation needed for continued hospitalization. This position assists with claims resolution issues and appeals, develops and maintains community relations, and collaborates with interdisciplinary team to achieve maximum internal and external customer satisfaction, as well as resource stewardship.

Requirements

Graduate from an accredited school of nursing, required.
At least three years of professional nursing experience required.
Current Washington State RN license required.
Basic Life Support (BLS) certification required within 30 days of hire.

Nice To Haves

BSN preferred.
Preference is for nursing experience to have occurred in a clinical/acute setting.
Experience in Utilization Management/In-Patient Case Management preferred.

Responsibilities

Monitors the appropriateness of hospital admissions and stays.
Consults with physician/supervisor as necessary to resolve deviations from established criteria
Obtains documentation needed for continued hospitalization.
Assists with claims resolution issues and appeals
Develops and maintains community relations
Collaborates with interdisciplinary team to achieve maximum internal and external customer satisfaction, as well as resource stewardship.