RN Care Manager | Utilization Review Specialist

2 weeks ago

University Place, WA, United States MLee Healthcare Staffing and Recruiting, Inc Full time

Join a dynamic healthcare team in the Pacific Northwest region as an RN Care Manager specializing in utilization review. This role involves coordinating care and managing service utilization for patients in acute and post-acute skilled care settings. You will collaborate closely with interdisciplinary teams both inside and outside the organization to enhance patient outcomes and optimize clinical and financial results.

Job Duties and Responsibilities

  • Continuously evaluate the appropriateness and timing of care levels, ensuring efficient use of resources based on patient needs.
  • Work alongside interdisciplinary teams to deliver cost-effective, patient-centered care that respects individual preferences and values.
  • Conduct patient rounds and assessments to support ongoing care needs during hospitalization and post-acute phases.
  • Develop and implement goal-oriented, age-appropriate care plans.
  • Coordinate care transitions from admission through discharge, collaborating with internal and external resources to ensure safe and effective patient transfers.
  • Identify and address discharge barriers promptly.
  • Educate patients and families on third-party payer guidelines to facilitate appropriate referrals.
  • Maintain thorough and timely documentation in accordance with departmental standards.
  • Support concurrent denial coordination, including peer-to-peer discussions with nurses or providers.
  • Adapt to evolving work environments and lead others through change.
  • Build and sustain professional relationships that foster trust and positive experiences for patients, colleagues, and customers.
  • Engage in continuous learning, skills training, and professional development.
  • Promote teamwork, support new team members, and contribute to a positive workplace culture.
  • Maintain confidentiality and uphold ethical standards.
  • Participate in strategic planning and special projects as assigned.
Education and Experience
  • Minimum of 2 years of registered nursing experience in acute care or care management/utilization review.
  • Current RN license valid in Washington or multistate.
  • Current Basic Life Support (BLS) certification.
  • Bachelor's degree in Nursing and Care Manager Certification are preferred.
Skills and Abilities
  • Strong organizational and prioritization skills.
  • Effective written and verbal communication tailored to diverse audiences.
  • Proficiency with technology and software, including intermediate to advanced Microsoft Office skills.
  • Ability to handle confidential information with discretion.
  • Demonstrated teamwork, collaboration, and customer service skills.
  • Capacity to work independently with sound judgment and problem-solving abilities.

This position offers a supportive work environment with opportunities for professional growth and a comprehensive benefits package designed to promote well-being and financial security. Embrace the chance to make a meaningful impact in a vibrant healthcare setting serving the Pacific Northwest region.

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