Nurse Specialist for Utilization Management
5 days ago
About the Role: We are seeking an experienced Nurse Specialist to join our team in a critical role of ensuring high-quality, cost-effective medical outcomes for patients.
Job Summary: This position involves reviewing precertification requests, conducting ongoing availability and monitoring of non-clinical staff activities, and establishing effective rapport with employees, customers, and healthcare providers. The successful candidate will possess excellent communication skills, critical thinking abilities, and a deep understanding of healthcare management principles.
Key Responsibilities:
- Precertification Requests Review: Conduct thorough reviews of precertification requests, referring complex cases to the Medical Director as needed.
- Clinical Information Review: Evaluate clinical information for concurrent reviews, utilizing expertise in healthcare management to ensure accurate and timely decisions.
- UMRN Program Implementation: Implement and oversee the Utilization Management Nurse program, monitoring and evaluating its effectiveness.
- Rapport Building: Develop strong relationships with employees, customers, and healthcare providers to facilitate effective communication and collaboration.
Requirements:
- Bachelor of Science in Nursing (BSN) degree required.
- Minimum of two years of experience in utilization management or a related field.
- Active, full, and unrestricted Registered Nurses (RN) licensed in Colorado or eligible for licensure via nurse compact state license.
- Knowledge of HIPAA regulations, accreditation standards, and Clinical Practice Guidelines.
- Familiarity with software and databases used in healthcare management, including Microsoft Office and Composite Health Care System (CHCS).
- Working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding.
- Basic Life Support (BLS) certification from the American Red Cross.
Preferred Qualifications:
- Certification by a Utilization Management-specific program, such as Certified Professional in Healthcare Management (CPHM).
- Proficiency in computer applications, including Microsoft Office programs and internet familiarity.
Compensation and Benefits: We offer a competitive salary range of $34.33 to $38.90 per hour, as well as an attractive benefits package that includes medical, dental, vision, group term life and AD&D insurance, voluntary life and AD&D insurances, voluntary long-term and short-term disability insurance, dependent spouse life insurance, dependent life insurance, prescription drug coverage, hearing coverage, 401(k) savings plan, employee assistance program, vacation and paid personal time, 11 paid federal holidays, and leave of absence.
Equal Opportunity Employer: Katmai is an equal opportunity employer, committed to providing a work environment free from discrimination and harassment. We welcome applications from diverse candidates and encourage those who share our values to apply.
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