Utilization Management Nurse I or II (IOP)

Job Description

Summary

Utilizing a collaborative approach, the Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient and IOP admissions utilizing clinical criteria.

This includes communication with the Physician's admitting patients to a Medical University of South Carolina facility and collaboration with the Physician Advisor during the review process.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC005312 CHS - Utilization Management (IOP)

Pay Rate Type

Hourly

Pay Grade

Health-28

Scheduled Weekly Hours

Work Shift

Job Description

Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required.

Prior leadership experience preferred. One year of case management and / or utilization management work experience preferred.

Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills.

Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required.

Experience in behavioral health is preferred.

Additional

Job Description

Physical Requirements : Ability to perform job functions while standing. (Continuous) Ability to perform job functions while sitting.

Continuous) Ability to perform job functions while walking. (Continuous) Ability to climb stairs. (Infrequent) Ability to work indoors.

Continuous) Ability to work outside in temperature extremes. (Infrequent) Ability to work from elevated areas. (Frequent) Ability to work in confined / cramped spaces.

Frequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to bend at the waist. (Continuous) Ability to twist at the waist.

Frequent) Ability to squat and perform job functions. (Frequent) Ability to perform "pinching" operations. (Frequent) Ability to perform gross motor activities with fingers and hands.

Continuous) Ability to perform firm grasping with fingers and hands. (Continuous) Ability to perform fine manipulation with fingers and hands.

Continuous) Ability to reach overhead. (Frequent) Ability to perform repetitive motions with hands / wrists / elbows and shoulders.

Continuous) Ability to fully use both legs. (Continuous) Ability to use lower extremities for balance and coordination.

Frequent) Ability to reach in all directions. (Continuous) Ability to lift and carry 50 lbs. unassisted. (Infrequent) Ability to lift / lower objects 50 lbs.

from / to floor from / to 36 inches unassisted. (Infrequent) Ability to lift from 36" to overhead 25 lbs. (Infrequent) Ability to exert up to 50 lbs.

of force. (Frequent) Examples include : To transfer a 100 lb. patient that can not assist in the transfer requires 50 lbs.

of force. For every 100 additional pounds, assistance will be required from another healthcare worker. 20 lbs. of force is needed to push a 400 lb.

patient in a wheelchair on carpet. 25 lbs. of force is required to push a stretcher with a patient with one hand. Ability to maintain 20 / 40 vision, corrected, in one eye or with both eyes.

Continuous) Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors.

Continuous) Ability to determine distance / relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities.

Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements.

Continuous) Ability to deal effectively with stressful situations. (Continuous) Ability to work rotating shifts. (Frequent) Ability to work overtime as required.

Frequent) Ability to work in a latex safe environment. (Continuous) Ability to maintain tactile sensory functions. (Continuous) (Selected Positions) *Ability to maintain good olfactory sensory function.

Continuous) *(Selected Positions) *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and / or federal regulations.

All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.

For further information about the E-Verify program, please click here : http : / / www.uscis.gov / e-verify / employees