Utilization Management RN
About The Position
St. Cloud Hospital is seeking a dynamic and experienced Utilization Management RN to join our team. In this pivotal role, the Utilization Management Nurse will play an integral part in determining the optimal level of care for each patient admission while ensuring adherence to regulatory guidelines and maximizing reimbursement. You will be responsible to conduct key components of the St Cloud Hospital Care Management and Utilization Review (UR) plans which includes activities to monitor for appropriate utilization of acute care services, identify and report quality indicators, required activities of utilization review, payer certification processes, and to identify performance improvement opportunities. Follows the guidelines of the Utilization Review Plan to assure cost-effective care and fulfills the requirement of the Center of Medicare and Medicaid Services Conditions of Participation (CoP) Utilization Review.
Requirements
- Bachelor's degree or higher in nursing required
- Registered Nurse (RN) Current licensure as a registered nurse in the State of Minnesota required
- 2+ years of relevant clinical experience or other related experience in any of the following functions: utilization review, performance improvement, quality assurance, risk management or case management related experience is required
- Acute care clinical experience required
- A working knowledge of medical legal issues in health care with special emphasis on documentation issues required
Nice To Haves
- Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement preferred
- Understanding of pre-acute and post-acute venues of care and post-acute community resources preferred
- Knowledge and background with Joint Commission and CMS CoP is highly beneficial.
Responsibilities
- Conduct key components of the St Cloud Hospital Care Management and Utilization Review (UR) plans which includes activities to monitor for appropriate utilization of acute care services
- Identify and report quality indicators
- Required activities of utilization review
- Payer certification processes
- Identify performance improvement opportunities
- Follows the guidelines of the Utilization Review Plan to assure cost-effective care
- Fulfills the requirement of the Center of Medicare and Medicaid Services Conditions of Participation (CoP) Utilization Review.
Benefits
- Starting pay begins at $41.34 per hour
- Pay range: $41.34 - $62.01 per hour
- Earn extra pay for working evening and weekend shifts!
- Tuition reimbursement and college grant programs available
- Part-time benefits: Medical, dental, PTO, retirement, employee discounts and more!
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
