Registered Nurse - Utilization Management

Department: Utilization Management-Remote but occasional in person

Scheduled Bi-Weekly Hours: 80

Daily Work Times: 8am to 4pm

Responsible for determining the appropriate patient status based on the regulatory and reimbursement requirements of various commercial and government payers in collaboration with the admitting/attending physician. Partners with the health care team to ensure hospital admissions are based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and continued stay are met and documented.  Along with other health care team members, monitors the use of hospital resources and identifies delays.  Reports delays to leadership for resolution.

⦁    Experience in utilization management/case management, critical care, clinical documentation, or patient outcomes/quality management. 
⦁    Certification in Case Management Certification (ACM or CCM)
⦁    Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training Network (MTN)