Clinical Utilization Manager RN
1 month ago
Bryan Health is seeking a skilled Clinical Utilization Manager RN to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the efficient and effective management of patient care.
Key Responsibilities- Conduct daily activities to coordinate clinical, financial, and utilization aspects of patient care.
- Collaborate with interdisciplinary teams, including hospital staff, physicians, and patient support, to ensure patient hospital stays meet medical necessity and insurance authorizations are obtained.
- Perform utilization review activities, including concurrent and retrospective reviews, to determine medical necessity of treatment requests.
- Collaborate with patient providers and healthcare teams to manage patient length of stay and determine continuing medical necessity of care.
- Refer cases to reviewing physicians when treatment requests do not meet criteria.
- Participate in concurrent and retrospective denials and appeals processes, researching issues and participating in all levels of appeal.
- Serve as an internal and external resource for appropriate level of care, admission status, Medicare/Medicaid rules, and discharge planning.
- Current Registered Nurse licensure from the State of Nebraska or approved compact state.
- Minimum of two years recent clinical experience required.
- Prior care coordination and/or utilization management experience preferred.
Basic Life Support (CPR) certification required.
Physical Requirements(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)
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