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ED Utilization Management RN

2 months ago

Gloucester City, United States Jefferson Health Full time

004863

Join the mission of Improving Lives as a Utilization Management RN at Jefferson Health. With more than 42,000 employees, we're the second largest employer in Philadelphia and the largest health system in the Philadelphia region. And our work to improve lives is never done.

Utilization Management RNs are responsible for the following:

  • Applies relevant medical necessity criteria to determine the appropriate patient status.
  • Collaborates with physician advisor to facilitate Case Management Condition 44 process.
  • Performs appeal process in coordination with specific payor protocols and timelines.
The Utilization Management RN performs utilization management functions and works collaboratively with members of the case management departments and healthcare team to ensure open lines of communication for optimal outcomes and patient care.

Qualifications
  • Bachelors of Nursing
  • Three (3) + years case management experience
  • Must be proficient with InterQual
Benefits include, but are not limited to:
  • Comprehensive Medical, Dental, & Vision Plans
  • Retirement Plans
  • Tuition Reimbursement
  • Health Coaching, Commuter Discounts, Day Care Services, etc.


Conditions of Employment

Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson's clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.

Closing Statement

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 42,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top healthcare systems in the country and the largest provider in the Philadelphia area, serves patients through millions of encounters each year at 17 hospitals and more than 160 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.