Job Description

The Utilization Management RN role will perform the duties of Utilization Management by demonstrating a multidisciplinary approach to identifying problems, communicating and negotiating with the patient’s PCP, family members, caregivers, and other members of the health care team, community resources and the Health Plans.

Essential Job Duties:

  • Works in conjunction with Case Management, Quality and other healthcare professionals to demonstrate a multidisciplinary approach in identifying problems, communication and negotiating with the patient’s PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans.
  • Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family.
  • May collect and report utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, as applicable.
  • Completes appropriate, accurate and timely, documentation into EMR system.
  • Reports questionable admissions, level of care, length of stays to the Director of Nursing, Clinical; reports quality of care issues to the Medical Director.
  • Is an active member of the Medical Care Review Committee representing Utilization Management as required by regulatory agencies.
  • Documentation in the EMR which is timely and accurate

 Other Duties:

  • Participation in weekly multidisciplinary team meetings
  • Provide support to patients and families who face the challenge of healing
  • Create forms necessary for accurate and thorough documentation

Minimum Qualifications:

  • Current RN license
  • 3 years nursing experience
  • Requires the ability to manage programs and projects.
  • Requires demonstrated excellence in interpersonal and written communication skills.
  • Experience with software applications and tools

Preferred Qualifications:

  • Previous experience with discharge planning and/or case management
  • Previous EMR experience

Physical Requirements/Working Conditions:

May be subjected to offensive odors and combative behavior.  May be exposed to communicable diseases including the HIV and HBV viruses.

Must be able to work paying close attention to detail with frequent interruptions.  Must be able to work independently with minimal supervision.

Application Instructions

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