Utilization Review Nurse Manager

2 weeks ago


Saint George, Utah, United States Intermountain Healthcare Full time

Job Overview:

The Nurse Case Manager leverages clinical knowledge and analytical skills to create and execute a care strategy that ensures efficient and exceptional patient care.

This role collaborates with patients, their families, healthcare professionals, insurance companies, community resources, and other stakeholders.

Compensation Details:
$63.79 Non-Exempt
Benefits Eligible:
Yes

Employment Type:
Part-time
Schedule: 24 hours/week, 8-hour shifts during the day.

Weekend and Holiday Work:
Required
Benefits:
Yes; includes Medical, Dental, Vision, and Education Assistance.

For further information, click here.

Key Responsibilities:
Organizes and prioritizes daily tasks by evaluating the needs of new, current, and discharged patients within assigned areas.

Completes necessary documentation as mandated.
Conducts utilization review processes to ensure patients receive timely, appropriate, and cost-effective care. Coordinates care among patients, healthcare providers, hospital financial services, and insurance payers.
Maintains an active role in preventing claim denials. Proactively engages with payers to avert inpatient denials. Conducts retrospective reviews on discharged patients as assigned. Communicates essential information to payers to facilitate appeals for existing denials. Utilizes level of care criteria to substantiate the patient's illness severity and service intensity. Reviews payer requirements and regulatory guidelines to guarantee safe and economical healthcare.
Facilitates and coordinates the discharge planning process from patient admission to discharge.

Evaluates patient needs, formulates a discharge plan, and collaborates with internal and external services for care during and post-hospitalization. Identifies patients at risk for avoidable delays, extended stays, readmissions, or discharge complications.

Works with care providers and leadership to achieve optimal outcomes.

Educates, communicates, and collaborates with various patient care teams to ensure quality care, timely discharges, and to identify and resolve any delays or issues.

Minimum Qualifications:
Current RN license for the state of practice.
Three years of clinical nursing experience.

RNs entering this role must possess or obtain their BSN within three years of hire or promotion.

Preferred Qualifications:
Bachelor's degree in Nursing (BSN) from an accredited institution. Degree verification required.
Certification in Case Management.
Experience in Case Management, Utilization Review, and/or Discharge Planning.

Physical Requirements:


Continuous need for the employee to see and read information, labels, monitors, identify equipment and supplies, and assess patient needs.

Frequent interactions with patients, care providers, and visitors necessitate effective verbal communication and the ability to hear and comprehend spoken information, alarms, needs, and issues quickly and accurately, especially in emergency situations.

Manual dexterity of hands and fingers is required to operate complex and delicate equipment with precision. This includes frequent computer use and typing for documenting patient care and accessing necessary information.

Equal Opportunity Employer:
Intermountain Healthcare is committed to diversity, equity, and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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