Utilization Management (UM) Specialist RN

MultiCare Health System • Phoenix, AZ

242d • $101,650 - $180,731

About The Position

The Utilization Management (UM) Specialist Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient's hospital stay. The UM Specialist Nurse 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 Specialist Nurse 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 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 five (5) years from the initial date of hire.
• RN with 15+ years of service may be considered in lieu of education agreement.
• Current Registered Nurse license in Washington State or Multistate License endorsement (MLS).
• Five years of clinical experience required; utilization management and/or insurance industry experience preferred.

Nice To Haves

• Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred.

Responsibilities

• Responsible for concurrent utilization management activities to a defined MHS Licensed Facility.
• Facilitates Utilization Review (UR) compliance and optimal reimbursement.
• Oversees the UR process including accurate admission and continued stay reviews based on CMS regulations.
• Serves as a resource for Utilization Management clinical and support staff.
• Provides guidance on troubleshooting complex cases.
• Assists with daily assignments of UM clinical and support staff.
• Participates in a collaborative team approach and works independently.

Benefits

• Comprehensive benefits package including competitive salary.
• Medical, dental and retirement benefits.
• Paid time off.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree