PRN Utilization Management Nurse

Position #: 24000A04
Position: PRN Utilization Management Nurse
UH Facility: University Hospitals
Shift: Days
Status: Per Diem
Work Days of Week: M-F, Rot wknd and Holidays

City: Shaker Heights

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ABOUT US

Your Nursing Talent Can Be The Difference.

Our UH health system cares for more than a million patients a year, one patient at a time. You chose a career in nursing because you wanted to help; to improve lives, including your own; and to have real impact. When it comes to choosing the perfect place to share and grow your talents, you deserve to be among those who share your passion and dedication too. That’s us.

Join Us and Be the difference in Advancing the Science of Health and the Art of Compassion.

We combine the best of evidence-based nursing with personalized care to provide the best healing experience for those we serve. The result is a different level of patient-focused healthcare and a different caliber of opportunity for our nurses.

Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.

JOB DESCRIPTION & QUALIFICATIONS

Description

Daytime hours, availability to work both weekdays and weekends required

A Brief Overview

Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in. Support of positive patient health care outcomes. Increased patient/health care team outcomes and satisfaction Improved inpatient throughput and appropriate length of stay Improved communication, awareness and adherence to regulatory requirements associated with utilization management Support for appropriate level of care and decreased inpatient bed day denials. Continuity and coordination of care Appropriate and timely authorization for level of care Decreased denials Appropriate reimbursement

What You Will Do

Performs timely and accurate admission and continued stay review in accordance with department policy to ensure efficient use of hospital resources, timely discharge and optimal, appropriate reimbursement (includes communication with internal and external customers).
Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to promote timely and effective communication, completion of workflow and services with regard to level of care decisions and payor decisions regarding continued stay.
Documents review activity, including but not limited to, application of criteria or policy as appropriate, clinical review to submit to insurance providers, initiation of registration changes when appropriate, outcomes and cost savings in a manner consistent with department requirements.
Meets department productivity and quality standards.

Additional Responsibilities

Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications

Education

Graduate of an accredited school of Nursing (Required)
Bachelor’s Degree (Preferred)

Work Experience

3+ years of clinical experience (acute care) (Required)
Prior UM experience (Preferred)
Additional experience in sub-acute setting, or managed care (Preferred)
2+ years of clinical experience with the population to be served. (Required)
Experience with Interqual or MCG criteria (Preferred)

Knowledge, Skills, & Abilities

Must have sound clinical knowledge base of the population to be served. (Required proficiency)
Knowledge of Medicare, Medicaid and commercial payer regulations (Preferred proficiency)
Detail-oriented and organized, with good analytical/critical thinking skills and problem solving ability. (Required proficiency)
Ability to function independently and as a team player in a fast-paced environment (Required proficiency)
Must have strong written and verbal communication skills. (Required proficiency)
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) (Required proficiency)
Demonstrated ability to apply concepts, utilize sound judgment and work independently within a framework of guidelines (Required proficiency)

Licenses and Certifications

Registered Nurse (RN), Ohio and/or Multi State Compact License Upon Hire (Required)
CM certificate (Preferred)

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LOCATION

Working at University Hospitals

Careers at University Hospitals offers opportunities to provide care locally in the Cleveland area with the power to impact healthcare nationwide. As a leader in our industry, our staff share a commitment to Be the Difference in the lives of our patients and our communities, from Northeast Ohio and beyond. Take a look at this video to discover how we’re building an organization for the future, today. Note: video content was obtained prior to the COVID-19 pandemic.

Learn More

Read Video Transcript

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Contact Us

To contact University Hospitals Human Resources department, or to request a reasonable accommodation, please call 216-767-8900 or send us an email at employment@uhhospitals.org

Equal Employment Opportunity Statement

It is the policy of University Hospitals to provide equal opportunity to all of our employees and applicants for employment. Decisions concerning employment, transfers and promotions or other conditions of employment are all made upon the basis of the best qualified candidate without regard to race, color, national origin, age, religion, veteran status, disability, gender, sexual orientation, gender identity, or marital status in accordance with Federal and Ohio law. A qualified individual with a disability will be considered for employment on the same basis as non- disabled applicants if he/she can perform the essential functions of the job sought, with or without a reasonable accommodation, and without imposing a direct threat to the health or safety of others or him/herself. EEO is the Law

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