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Utilization Management Specialist RN

2 months ago

Saint Paul, Minnesota, United States Fairview Health Services Full time
Job Summary

We are seeking a highly skilled Utilization Management Specialist RN to join our team at Fairview Health Services. This role will play a critical part in ensuring the efficient and effective delivery of patient care across our system.

Key Responsibilities
  • Conduct comprehensive assessments of patient care needs and develop individualized plans to optimize resource utilization.
  • Collaborate with interdisciplinary teams to ensure seamless transitions of care and minimize unnecessary hospitalizations.
  • Utilize evidence-based criteria to determine the appropriateness of patient care levels and lengths of stay.
  • Communicate effectively with patients, families, and healthcare providers to ensure informed decision-making and optimal outcomes.
  • Stay up-to-date with regulatory requirements and industry best practices to ensure compliance and quality improvement.
Requirements
  • Bachelor's degree in Nursing or related field.
  • Current RN licensure in Minnesota.
  • 3-5 years of experience in utilization review, case management, or a related field.
  • Prior experience with Epic EMR and medical necessity screening criteria (e.g., InterQual or MCG) is highly preferred.
Preferred Qualifications
  • Minimum 1 year of experience with Epic EMR.
  • Minimum 1 year of experience using medical necessity screening criteria.
  • 3-5 years of acute care hospital nursing experience.
  • Excellent computer and database management skills.
  • Ability to work independently, prioritize tasks, and communicate effectively with diverse stakeholders.