Utilization Management RN Wanted!

• Review clinical information for concurrent reviews, extending the Length of Stay for inpatients as appropriate.

• Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:

o promote decreased lengths of hospital stays when appropriate

o prevent complications in patients under our care when possible

o assure appropriate levels of care are received by patients

• Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available resources.

• Gathers all pertinent information from providers and facilities to ensure physician reviewers have sufficient information to make a decision to approve or deny services.

• Coordinates with non-clinical staff to ensure all documentation is completed timely and in a professional manner.

• Interfaces with internal resources including Medical Directors and other Health Services staff to ensure members receive the right care at the right time in the right setting by the right provider.

Personal qualities that are desirable include the ability to work under stress, both with and without supervision; attention to detail and a tolerance for handling a heavy workload. Professional nursing theory, principles, and practices are also required. Demonstrated interpersonal and technical skills including the following:

• Effectively apply acute care medical/surgical nursing practices.

• Use clinical guidelines for medical necessity determinations.

• Demonstrated ability to problem-solve complex, multifaceted, emotionally charged situations.

• Ability to successfully manage conflict, negotiating “win-win” solutions.

• Strong organizational, task prioritization and delegation skills.

• Knowledge of required regulatory timelines to ensure department compliance with State contracts.

• Knowledge of basic computer applications with ability to adapt to new software programs.

All candidates must have a registered nursing degree, preferably at the baccalaureate level, as well as some experience in the field of case management and/or utilization review.

If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document. We look forward to hearing from you today!