Utilization Management Nurse II - Surgical - Remote

Overview

The Utilization Management Nurse (UMN) plays a crucial role in ensuring optimal reimbursement through accurate patient certification and compliance with regulatory requirements.

In Short

• Conducts utilization reviews for patient care appropriateness.
• Monitors patient charts and treatment plans.
• Consults with multidisciplinary teams and stakeholders.
• Ensures adherence to Medicare and Medicaid regulations.
• Requires a Bachelor's degree in Nursing and five years of experience.
• Preferred experience in surgical clinical settings.
• Excellent communication skills are essential.
• Familiarity with InterQual or MCG criteria is desired.
• Must be licensed as a registered nurse in South Carolina or a compact state.
• Ability to perform physical tasks and work rotating shifts.

Requirements

• Bachelor's degree in Nursing.
• Five years of nursing experience.
• Two years in utilization or case management.
• Leadership experience preferred.
• Committee involvement in healthcare settings.
• Strong verbal and written communication skills.
• Physical ability to perform nursing tasks.
• Computer literacy required.
• Ability to deal with stressful situations.
• Must maintain licensure as a registered nurse.

Benefits

• Opportunities for career advancement.
• Work with a dynamic team.
• Access to extensive healthcare resources.
• Participation in research and innovation.
• Supportive work environment focused on patient care.