The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines.
Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients.
UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner.
For a complete understanding of this opportunity, and what will be required to be a successful applicant, read on.
Required Skills
- Excellent verbal and written communication skills
- Ability to follow chain of command
- Highly developed ability to multi-task and maintain focus
- Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving
- Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills with minimal supervision.
- Strong organizational skills
- Basic computer skills : Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
- Type 50 WPM
- Ability to apply appropriate UM criteria
Required Experience
- Current licensure as an RN in the state of California.
- A minimum of 2 years of bedside nursing experience in an acute care setting.
- A minimum of 2 years of case management experience.
- Knowledge of payer requirements.
Preferred :
- Certified Case Manager or Accredited Case Manager
- BSN preferred
- Experience with Milliman Care Guidelines (MCG)
Address : 11500 Brookshire Ave.
Salary : 49.27-81.30
Shift : Days
FLSA Status : Non-Exempt
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