RN Utilization Management Specialist

4 days ago


Newport News, Virginia, United States Riverside Health System Full time
About the Role

We are seeking a skilled RN Utilization Management Specialist to join our team at Riverside Health System. As a key member of our healthcare team, you will play a critical role in ensuring the judicious management of health system resources.

Key Responsibilities
  • Provide initial medical necessity reviews for patients hospitalized within the organization, adhering to national guidelines and standards of excellence.
  • Contribute to decision-making and decision support as a member of the interdisciplinary team.
  • Align practice with the organization's mission and vision, advancing the application of research and evidence-based practices.
  • Maintain current knowledge of healthcare economics, trends, and reimbursement methodologies, and apply this knowledge to daily practice.
  • Communicate effectively and professionally regarding modality, providing education to patients, families, and other members of the care team as needed.
Requirements
  • Program Graduate, Professional Nursing (Required)
  • 3-4 years Clinical nursing experience (Required)
  • Excellent verbal and written communication skills
  • Excellent interpersonal skills
  • Excellent organizational skills and attention to detail
  • Ability to act with integrity, professionalism, and confidentiality
  • Proficiency with computer systems required to perform job
  • Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) (Required)
  • Certified Case Manager (CCM) - Commission for Case Manager Certification (Preferred) or Accredited Case Manager (ACM) - American Case Management Association (ACMA) (Preferred)
About Riverside Health System

Riverside Health System is a leading healthcare provider in the region, dedicated to delivering high-quality patient care and advancing the health and well-being of our community.



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