RN | Utilization Management | Evenings
5 days ago
Overview Monday-Friday 3p to 11:30p Emergency Department NOT REMOTE The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager is responsible for ensuring that care is provided at the appropriate level of care based on medical necessity. In addition, the Utilization Manager will work towards denial prevention, promote appropriate length of stay, and ensure compliance with state and federal regulatory requirements. The Utilization Manager will work with payers to support admission, level of care, length of stay, and authorizations for services provided. Responsibilities Clinical review on all assigned patients performed to document if MCG criteria met in the appropriate setting (Inpatient or Observation). Review includes completion of Important Message from Medicare and Medicare Outpatient Observation Notices as required by Medicare and Medicare Advantage Plans. Application of MCG SI/IS criteria to assure necessity of admission/CSR (including all adults and pediatrics). Effectively summarizes and refers cases not meeting criteria to Physician Advisor. Applies regulatory requirements and policy concerning observation regarding time limitations in observation, physician order for observation, physician conversion order to inpatient, and determining the appropriate diagnostic test setting for outpatient versus inpatient. Collaborates daily with the direct care givers (care coordination, nurses, and physicians, ancillary departments) to coordinate the patient's length of stay, timely utilization, and appropriateness of those resources. Collaborates with care coordination in event of necessary referral cases. Provides documentation review to certify the admission and/or continued length of stay to the third party payers; negotiating for additional days if necessary. All documentation noted in ACM. Tracking of Avoidable Days in ACM by completing the necessary user defined fields of data. Uses this data to address opportunities for improvement. Flags cases for the Risk Manager and Quality Assurance Coordinator regarding adverse events, appropriateness of procedures, and quality of care issues. Enters Medicaid chart data into the eQHS computerized system to obtain appropriate authorization and approval of continued stay days. Also assures timely inputs of Medicaid retro reviews when eligibility is confirmed. Identifies opportunities for improvement in the hospital system processes as well as suspected problems of under or over utilization in inappropriate scheduling of services and bring attention to the Utilization Management Manager. Observes rules of confidentiality specific to the Utilization Management Department (information obtained in files, committee discussions, data security, proper disposal of QA information, etc). All other duties as assigned by department. Qualifications Education required: Associates in nursing Experience required: 3 year acute care nursing Experience preferred: Acute care utilization management Accredited Case Manager (ACM)
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RN | Utilization Management | Evenings
2 weeks ago
Saint Augustine, FL, United States University of Florida Health Full timeRN | Utilization Management | EveningsOverview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for...
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RN | Utilization Management | Evenings
2 weeks ago
Saint Augustine, FL, United States University of Florida Health Full timeRN | Utilization Management | EveningsOverview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for...
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RN Utilization Management Evenings
3 weeks ago
St Augustine, United States University of Florida Health Full timeRN Utilization Management Evenings Overview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring...
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RN | Utilization Management | Evenings
2 hours ago
St Augustine, United States University of Florida Health Full timeRN | Utilization Management | Evenings Overview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for...
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RN | Utilization Management | Evenings
1 month ago
Saint Augustine Beach, Florida, United States University of Florida Health Full timeJob SummaryThe RN Utilization Manager is a key member of the care team, responsible for ensuring that patients receive the appropriate level of care based on medical necessity. This role requires strong clinical knowledge, effective communication skills, and the ability to work collaboratively with healthcare professionals to achieve optimal patient...
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Hospital Utilization Management RN
3 weeks ago
Tulare, CA, United States Clinical Management Consultants Full timeA well-established hospital in the California Central Valley is actively searching for a Utilization Management RN to join their team. This 150+ bed short-term acute care hospital has proudly provided care to San Joaquin Valley residents for over half a century. Medical services include 24-hour Emergency Services, OB Services, Pediatrics, Physical...
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Hospital Utilization Management RN
8 hours ago
Tulare, CA, United States Clinical Management Consultants Full timeA well-established hospital in the California Central Valley is actively searching for a Utilization Management RN to join their team. This 150+ bed short-term acute care hospital has proudly provided care to San Joaquin Valley residents for over half a century. Medical services include 24-hour Emergency Services, OB Services, Pediatrics, Physical...
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Utilization Management Nurse
1 week ago
Tulsa, OK, United States Saint Francis Health System Full timeThis position is ECB status - requires a minimum number of worked hours per month as needed by the department; limited benefit offerings. #ALDIND Shift: Evenings Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of patients including, but not limited to their placement in various levels of...
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RN | Utilization Management | PRN
3 weeks ago
St Augustine, United States UF Health Full timeOverviewThe RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring that care is provided at the appropriate level of care based on medical necessity. In...
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RN | Utilization Management | PRN
3 weeks ago
St Augustine, United States UF Health Full timeOverview The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring that care is provided at the appropriate level of care based on medical necessity....
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Assistant Nurse Manager
1 week ago
Portland, OR, United States Providence RN Full timeDescription The Assistant Nurse Manager (ANM) is a professional Registered Nurse reporting to the unit director/manager who utilizes the nursing process to manage clinical and operational activities within assigned shift. The ANM is responsible for supporting the director/manager in planning, organizing, directing, and evaluating services of the...
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RN Utilization Management
2 weeks ago
Boise, ID, United States LanceSoft Inc Full timeJob Description: Tittle: RN Utilization Management Location: Boise, ID Duration: 13 weeks Guranteed hours: 40 hrs Pay Package: Total weekly gross $4171 W2: $60/hr Per Diem/Stipend: $1771/weekly non taxable Shifts: Mon-Fri 8am-5pm Minimum Years of Experience: 5+yrs Sub Specialty: Utilization Management, Case Management (Utilization Review) General...
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Assistant Nurse Manager
4 days ago
Portland, OR, United States Providence RN Full timeDescription The Assistant Nurse Manager (ANM) is a professional Registered Nurse (RN) reporting to the unit RN manager who utilizes the nursing process to manage clinical and operational activities within assigned shift. The ANM is responsible for supporting the RN manager in planning, organizing, directing, and evaluating services of the unit and...
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Nurse Manager Surgical Services
2 weeks ago
Saint Augustine, FL, United States Clinical Management Consultants Full timeJoin our dynamic team at a prestigious healthcare facility located near St. Augustine, FL! We are seeking a dedicated Nurse Manager Surgical Services to lead the Surgical Services team. This facility, renowned for its unwavering commitment to delivering excellence in quality and safety, is a 110-bed acute care hospital dedicated to serving the local...
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Nurse Manager Surgical Services
2 weeks ago
Saint Augustine, FL, United States Clinical Management Consultants Full timeJoin our dynamic team at a prestigious healthcare facility located near St. Augustine, FL! We are seeking a dedicated Nurse Manager Surgical Services to lead the Surgical Services team. This facility, renowned for its unwavering commitment to delivering excellence in quality and safety, is a 110-bed acute care hospital dedicated to serving the local...
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Nurse Manager Surgical Services
2 weeks ago
Saint Augustine, FL, United States Clinical Management Consultants Full timeJoin our dynamic team at a prestigious healthcare facility located near St. Augustine, FL! We are seeking a dedicated Nurse Manager Surgical Services to lead the Surgical Services team. This facility, renowned for its unwavering commitment to delivering excellence in quality and safety, is a 110-bed acute care hospital dedicated to serving the local...
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Assistant Nurse Manager
1 week ago
Portland, OR, United States Providence RN Full timeDescription The Assistant Nurse Manager (ANM) is a professional Registered Nurse reporting to the unit director/manager who utilizes the nursing process to manage clinical and operational activities within assigned shift. The ANM is responsible for supporting the director/manager in planning, organizing, directing, and evaluating services of the...
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Utility Project Manager
1 week ago
Manchester, ME, United States FootBridge Company Full timeTitle: Utility Project Manager Ready to apply Before you do, make sure to read all the details pertaining to this job in the description below. Salary: 125K to 145K Location: Manchester, Maine Duration: Permanent/Direct-Hire Join our team as a Utility Project Manager (UPM) and lead exciting projects with flair! You'll juggle schedules, budgets, and...
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Assistant Nurse Manager
17 hours ago
Portland, OR, United States Providence RN Careers Full timeDescription The Assistant Nurse Manager (ANM) is a professional Registered Nurse (RN) reporting to the unit RN manager who utilizes the nursing process to manage clinical and operational activities within assigned shift. The ANM is responsible for supporting the RN manager in planning, organizing, directing, and evaluating services of the unit and providing...
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Utilization Management RN
7 days ago
Atlanta, GA, United States Piedmont Healthcare Corporate Full timeDescription:RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures...
