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Utilization Management Nurse

2 months ago

Dayton, Ohio, United States Shaker for ChristianaCare Direct Full time
Job Summary

We are seeking a highly skilled Utilization Management Nurse to join our team at Shaker for ChristianaCare Direct. As a key member of our healthcare team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.

Key Responsibilities
  • Utilization Management: Perform admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
  • Collaboration and Communication: Work collaboratively with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, and Clerical Support staff to ensure seamless communication and coordination of care.
  • Performance Improvement: Monitor compliance with National Patient Safety Goals within assigned units and assist with data collection and implementation of action plans for CMS, JCAHO, AHA Quality Initiatives as well as CCHS defined measures.
  • Leadership and Education: Serve as a resource to nursing and ancillary staff, providing education on utilization review processes as needed, and actively participate in department operational planning work groups.
Requirements
  • Education: Bachelor's degree in nursing
  • Experience: Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting
  • Clinical Skills: Clinical documentation, performance improvement, case management, or utilization management experience desirable
  • Professional Development: Completes a minimum of 8 continuing education credits (CEU's) per year in Utilization and/or Case Management
What We Offer
  • Competitive Compensation: Special rate of pay and full benefits, except for Paid Time Off (PTO)
  • Professional Growth: Opportunities for professional development and growth within the organization
  • Work-Life Balance: Generous paid time off with annual rollover and opportunities to cash out
  • Wellness and Benefits: Access to backup care services for dependents, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors