University of Washington-posted 11 months ago
Part-time • Mid Level
Remote • Seattle, WA
Educational Services

UW Medical Center has an outstanding opportunity for an experienced Utilization Review Nurse (UM RN) to join our team. This position ensures the delivery of optimal care for our patients while promoting fiscal responsibility. The UM RN maintains efficient, cost-effective care management processes by determining the medical necessity and financial liability for all hospitalized patients. This role plays a key part in ensuring compliance with regulatory requirements, policies, and procedures.

  • Identify clinical indications for admission
  • Track hospital events and course in order to justify patient admission and continued stay for payer reimbursement
  • Communicate with third party payers regarding patient clinical progress
  • Assess and communicate potential reasons for payer denials and attempts to resolve the denial with the team at the time of identification
  • Participate in activities of identifying high risk vulnerabilities to the organization
  • Use critical thought processes and decision making in monitoring the continuum of care
  • 3 years of work experience in utilization management
  • 5 years of nursing work experience in an acute care med-surg setting
  • Bachelor's Degree in Nursing, or equivalent education and training
  • Active licensure to practice as a Registered Nurse in Washington State required by start date
  • Knowledge of medical screening criteria
  • Computer skills to appropriately navigate electronic charting and referral systems, specifically Xsolis software.
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service