Registered Nurse Utilization Management Specialist
Location
West Des Moines, IA | United States
Job description
We're seeking a RN Utilization Management Specialist to join our team! Under the direction of the Manager of Utilization Management, this position serves a key role in coordinating the organization’s interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care, optimal clinical outcomes, and patient and provider satisfaction. The RN UM Specialist will work to track and minimize the inappropriate use of such resources.
Shift: Evenings, Full Time (11AM to 8PM)
This position is open to remote/work from home with strong preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.
Why UnityPoint Health?
- Commitment to our Team –We’ve been named a Top 150 Place to Work in Healthcare 2022by Becker’s Healthcare for our commitment to our team members.
- Culture – At UnityPoint Health, you Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
- Benefits – Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.
- Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
- Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
- Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.
Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.
- Performs utilization management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources.
- Maximizes positive financial outcomes for patients and hospital by conducting timely initial and ongoing concurrent chart review for hospitalized patients to monitor appropriateness of treatment, resource utilization, quality of care.
- Applies utilization criteria using designated software to complete documentation related to utilization review activities in an accurate and timely manner for the purpose of providing information for other members of the healthcare team and to facilitate decision making.
- Requests secondary reviews with physician advisors as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.
- Assesses patient status, including reviewing outpatient surgical and observation admissions for the appropriate level of care, and continuously monitors length of stay for appropriate and timely medical management.
- Serves as a resource to internal and external staff, providers, payers, and patients on issues related to utilization management
- Maintains current knowledge of Utilization Review Methodology, software, criteria, and regulations governing various payment systems.
- Maintains current knowledge of the UPH Utilization Management Plan.
- Maintainscurrent knowledge of CMS rules (e.g., Code 44, A –B Rebilling, HINN, etc.) and other regulatory agencies requirements to insure appropriate reimbursement.
Education
- Associates Degree or Diploma (RN) in Nursing
- Bachelor’s Degree or higher preferred in nursing, business,or related field
Experiece
- 2 years of nursing experience
- 5+ years of nursing experience preferred
- Experience in Utilization Management, case management, denials,or managed care highly preferred
- Management experience a plus
License(s)/Certification(s)
- Registered Nurse –Licensed and registered in the appropriate state(s)
Job tags
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