RN Utilization Review
2 weeks ago
Utilization Review RN, Case Management
Why Mount Carmel?
With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years. As a proud member of Trinity Health, one of the nation's largest Catholic healthcare delivery systems, our network of caring spans 22 states, 94 hospitals, and 133,000 colleagues nationwide.
We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.
What we offer:
- Competitive compensation and benefits packages including medical, dental, and vision coverage
- Retirement savings account with employer match starting on day one
- Generous paid time off programs
- Employee recognition incentive program
- Tuition/professional development reimbursement
- Relocation assistance (geographic restrictions apply)
- Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing
About the job:
The RN Case Manager, Utilization Review ensures that services are delivered in a manner that balances quality of care with efficiency, cost-containment and compliance.
What you'll do:
- Conduct Utilization Management review for Inpatient and Outpatient cases.
- Analyze, summarize, and concisely report medical utilization and medical chart audit results.
- Compare clinical information to determine appropriateness of service and to document all related information according to department policies and procedures.
- Coordinate with the utilization review, case management, and discharge planning colleagues as needed.
- Collaborate with medical directors/providers and other operational departments such as Claims, Denials, etc. regarding applicable case-specific issues.
What we're looking for:
- Graduate of an accredited school of nursing.
- Licensure / Certification: Current license to practice as a Registered Nurse (RN) in the State of Ohio.
- Experience: Three (3)+ years of relevant clinical work experience required; Two (2)+ years' experience in utilization review, discharge planning, or case management preferred.
* The hire will need be to able to train a few days during the week.
*This is a casual / PRN position.
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Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
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