Utilization Mgmt RN
About The Position
The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.
Requirements
- Associates Degree Nursing (required)
- RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
- Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
- Knowledge of UM regulations.
- Knowledge of private and public payer reimbursement practices and procedures.
- Excellent organizational and communication skills and ability to work with a variety of health care professionals.
- Ability to work independently.
- Proficiency with word processing, spreadsheets and database software.
- ability to perform each essential duty satisfactorily
Nice To Haves
- Bachelors Degree Nursing or related field (preferred)
- Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Responsibilities
- daily screening of patient admission relative to specified criteria
- active involvement in denial management
- acting as a resource to staff regarding clinical criteria
- communication with payors to address concerns
- ensure compliance with regulatory, organizational and department requirements
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Associate degree
