Utilization Management Nurse - Remote

Overview

As a Utilization Management Nurse, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses. Proficient in Utilization Review processes, you'll maintain effective procedures to meet regulatory and reimbursement requirements for various payers, both commercial and government.

In Short

• Conduct concurrent and continued stay Utilization Management reviews.
• Lead or participate actively in process improvement initiatives.
• Efficiently manage a diverse workload in a fast-paced environment.
• Foster positive collaboration with the Care team.
• Ensure accurate data tracking, evaluation, and reporting.
• Maintain compliance with federal and state regulations.
• Work with various departments and multi-disciplinary teams.
• Support timely patient progression during their stay.
• Utilize knowledge of third-party payers and managed care principles.
• Contribute to patient-focused care initiatives.

Requirements

• Current PN Nurse license.
• Associate's degree preferred.
• 2 years of Utilization Management experience.
• Hospital case management experience is advantageous.
• Proficiency in federal and state regulations.

Benefits

• Full benefit package available with employer contribution.