RN Utilization Management Specialist
2 days ago
Gundersen Health System is seeking a skilled Registered Nurse to join our Utilization Management team. As a RN Utilization Management Specialist, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes.
Job Summary:The RN Utilization Management Specialist will be responsible for reviewing medical records to determine medical necessity and level of care for hospitalizations. This role requires strong clinical knowledge and analytical skills to evaluate patient data and make informed decisions.
Key Responsibilities:- Conduct thorough reviews of medical records to determine medical necessity and level of care for hospitalizations
- Collaborate with healthcare teams to ensure that patient needs and discharge plans are documented and certified as medically necessary
- Communicate review determinations to attending physicians and external review organizations as required
- Monitor patient progress and outcomes towards goals
- Assist with management of healthcare benefits and coordination of services
- Participate in performance improvement activities to achieve safe quality patient care and assure compliance with regulations and contracts
- Associate degree in Nursing
- Minimum of 2 years of experience in nursing, case management, or utilization management
- Registered Nurse (RN) licensed in the state of practice
Gundersen Health System offers a competitive salary and benefits package, including a top-rated retirement plan and healthcare benefits. We also offer opportunities for career growth and development through our Career Development Center and Tuition Investment Program.
Join our team and contribute to the delivery of world-class medical care combined with the right amount of love. Apply today to become a RN Utilization Management Specialist at Gundersen Health System
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