Inpatient RN UM Specialist (Remote Eligible)

Point32Health, Inc.; United States; Hybrid; USD 94,000 - 142,000; Full time

Job summary

Point32Health seeks an experienced Clinical Reviewer, Inpatient RN, to manage clinically complex inpatient cases across multiple lines of business. You will apply criteria to determine medical necessity and level of care, support discharge planning, and mentor team members.

The role requires Massachusetts RN licensure and at least three years of clinical nursing and UM experience. You may collaborate with providers and participate in weekly rounds to improve patient outcomes.

Qualifications

• Registered nurse with current, unrestricted Massachusetts RN license.
• Minimum 3 years of clinical nursing experience and 3 years of Utilization Management experience.
• Ability to mentor and lead staff, collaborate with teams, and manage multiple tasks.

Responsibilities

• Provide a range of utilization management activities for inpatients (acute and post-acute).
• Determine medical necessity and schedule concurrent reviews.
• Perform discharge planning and identify complex members for case management.
• Collaborate with providers to transition members to appropriate care settings.
• Support Inpatient Management Initiatives and participate in Consultive Rounds.

Skills

People skills

Communication

Negotiation

Multitask

Mentor

Independence

Time management

Tech literacy

Learning new tech

Education

Associate degree in Nursing

BSN

Tools

MedHOK

Case Trakker

Jiva

Microsoft Word

Excel

Job description

Point32Health seeks an experienced Clinical Reviewer, Inpatient RN, to manage clinically complex inpatient cases across multiple lines of business. You will apply criteria to determine medical necessity and level of care, support discharge planning, and mentor team members.

The role requires Massachusetts RN licensure and at least three years of clinical nursing and UM experience. You may collaborate with providers and participate in weekly rounds to improve patient outcomes.