Utilization Management Nurse - Day Shift

Christiana Care Health Services•Elkton, MD

11d•Onsite

About The Position

ChristianaCare - Union Hospital is seeking a Utilization Management Nurse with experience in Utilization Management and Acute Care. The RN will be responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan. This role involves ongoing contact with patients/families, medical-dental staff, nursing, social work, PI-outcome coordinators, disease management, and ancillary services, as well as home health care providers, durable medical equipment providers, insurance/managed care organizations, and community resources.

Requirements

Active MD RN licensure or compact state RN licensure, in good standing.
DE RN licensure or compact state RN licensure, in good standing.
BSN required. In lieu of BSN, at least six years of experience as a Registered Nurse in Clinical Documentation, Performance Improvement, Case Management or Utilization Management experience required.
Minimum of 5 years recent experience as a Registered Nurse in acute care, adult care setting.
Registered RN licensed to practice in the State of DE and/or MD required.
Strong interpersonal skills relative to both professional and lay interactions.
Strong organizational skills.
Working knowledge of Performance Improvement activities.
Working knowledge of data management/reporting practices.

Responsibilities

Ensuring the delivery of efficient and effective health care.
Evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan.
Completes a minimum of 8 continuing education credits (CEU’s) per year in Utilization and/or Case Management.
Actively participates in department operational planning work groups.