Utilization Management Spec RN

MultiCare Health System

1d•$98,336 - $174,826•Onsite

About The Position

Join a team that shares your calling At MultiCare, you’re more than just a job title — you’re part of a team built on trust that cares for each other, our patients and our communities. Belonging here means living our mission and values every day. If your purpose and passions align with ours, you’ll find a place to grow, do meaningful work and build a career you love in a community that feels like home. FTE: 1.0, Shift: Days, Schedule: M-F, variable hours. Position Summary The Utilization Management (UM) Principal Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility Principal UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient’s hospital stay. The Principal facilitates Utilization Review (UR) compliance, and optimal reimbursement through oversight of their assigned licensed facility’s UR process including: accurate admission and continued stay reviews based on CMS regulations, UM criteria, certification and/or authorization, and complete chart documentation. The UM Principal serves a resource for Utilization Management clinical and support staff. This position assists with providing guidance on troubleshooting with complex cases and also assists with daily assignments of UM clinical and support staff to ensure patients are patients receiving timely and accurate reviews. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management. Work situations require specialized knowledge, judgment and skill and this position requires organization and interpretation of information relating to a wide variety of policies, procedures and programs.

Requirements

Bachelor’s degree in Nursing, or obtained within three years from the original date of hire
Currently licensed as a nurse (State of Washington)
Five years of clinical experience required

Nice To Haves

Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
utilization management and/or insurance industry experience preferred

Responsibilities

Responsible for concurrent utilization management activities to a defined MHS Licensed Facility.
Facilitates Utilization Review (UR) compliance, and optimal reimbursement through oversight of their assigned licensed facility’s UR process including: accurate admission and continued stay reviews based on CMS regulations, UM criteria, certification and/or authorization, and complete chart documentation.
Serves as a resource for Utilization Management clinical and support staff.
Assists with providing guidance on troubleshooting with complex cases.
Assists with daily assignments of UM clinical and support staff to ensure patients are receiving timely and accurate reviews.
Participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management.