About The Position
The Utilization Management Nurse (UM RN) supports quality care and efficient use of healthcare resources across the healthcare continuum. The role contributes to interdisciplinary collaboration, resource stewardship, care coordination, and positive patient outcomes, serving as a clinical advisor and resource utilization expert for care teams. The position is based in Lees Summit, Missouri, and is listed as work from home. It is full-time, scheduled 7:00 a.m. to 4:00 p.m. on varied days per week, for 40 hours per week.
Requirements
- Active RN license in the state of Missouri.
- Two years of clinical experience in an acute hospital setting.
- Proficiency with Windows-based programs and electronic health records.
- Strong verbal, written, and interpersonal communication skills.
- Excellent critical-thinking, problem-solving, and organizational skills.
- Ability to thrive in a fast-paced, team-oriented environment.
Nice To Haves
- BSN preferred, or a graduate degree in Nursing if a BSN is not held.
- Previous Utilization Management experience.
- Familiarity with managed care, TJC, CMS standards, and performance improvement.
- Knowledge of ICD/CPT/DRG coding systems.
- Behavioral Health experience.
- Experience analyzing data or working with utilization metrics.
- National certification in Utilization Management or Case Management, such as ACM, CCM, or CMAC.
Responsibilities
- Partner with interdisciplinary teams to ensure effective and efficient use of healthcare resources.
- Monitor patient care delivery to align with best practices, regulatory standards, and financial goals.
- Advise clinical staff on utilization practices, clinical documentation, and discharge planning.
- Use data and clinical judgment to support timely transitions of care and optimize care coordination.
- Participate in quality and performance improvement initiatives focused on resource utilization and patient-centered care.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
