ED Utilization Mgmt RN Care Coordination Full Time Evenings
About The Position
This position is in the ED: 6:00pm -2:00AM. Monday through Friday. No weekends /holidays. This is not a remote position. The Utilization Management RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Utilization Management nurse role is to ensure that health care services are administered with quality, cost efficiency, and within compliance by continuously reviewing the EMR and collaborating with the health care team.
Requirements
- Bachelor's degree in Nursing
- State licensure as a Registered Nurse (RN)
Nice To Haves
- Master's degree
- Minimum 2 years of prior experience in Utilization Management
- Utilization Management or Case Management certification
Responsibilities
- Concurrent review of patients clinical information for efficiency and correct level of care and admission status
- Interface with payers concurrently and after discharge to obtain authorization
- Concurrent denials management
- Collaborates with the denials management team
- Ongoing review of pre-certification requests for medical necessity
- Monitor the activities of clinical and non-clinical staff
- Collaborates with the health care team and payers to assist with coordinating patients discharge planning needs
- Employ effective use of knowledge, critical thinking and skills
- Work in an intensive, fast-paced environment with minimal supervision
- Ability to stay organized and interact well with others in any situation
- Provide updates to Director of Utilization Management for review
Benefits
- We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees.
- We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events.
- Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
