Utilization Management Nurse

Job not on LinkedIn

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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University Hospitals

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

💰 $2M Grant on 2021-07

Healthcare • Medical Services • Education

University Hospitals is a leading healthcare provider that offers a wide range of medical services, including primary care, specialty care, and urgent care. With a focus on patient-centered care, UH also engages in medical education and research, ensuring high-quality treatment and innovative healthcare solutions. The institution is recognized nationally for its excellence in various medical specialties, providing accessible healthcare to the community and beyond.

📋 Description

• Perform timely and accurate admission and continued-stay reviews according to department policy • Ensure efficient use of hospital resources, timely discharge, and appropriate reimbursement • Communicate with internal and external customers regarding clinical reviews • Coordinate with healthcare team members, patients, and families on level-of-care and payer decisions • Document review activity, criteria or policy application, clinical reviews, registration changes, outcomes, and cost savings • Meet department productivity and quality standards • Support positive patient outcomes, inpatient throughput, appropriate length of stay, continuity of care, timely authorization, and reduced denials • Perform other assigned duties • Comply with policies, standards, and protected health information requirements

🎯 Requirements

• Graduate of an accredited school of Nursing (Required) • 3+ years of clinical experience in acute care (Required) • 2+ years of clinical experience with the population to be served (Required) • Registered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire) • Sound clinical knowledge base of the population to be served • Detail-oriented and organized, with analytical/critical thinking and problem-solving skills • Ability to function independently and as a team player in a fast-paced environment • Strong written and verbal communication skills • Ability to use PCs, Microsoft Office suite, and general office equipment • Ability to apply concepts, utilize sound judgment, and work independently within guidelines • Additional experience in sub-acute setting or managed care (Preferred) • Prior utilization management experience (Preferred) • Experience with InterQual or MCG criteria (Preferred) • Knowledge of Medicare, Medicaid, and commercial payer regulations (Preferred) • CM certificate (Preferred)

🏖️ Benefits

• Part-time regular employment • Day shift • Remote work • No travel