RN - Utilization Management - FT

IntelliResume; City of Binghamton (NY); On-site; USD 50,971 - 73,012; Full time

Benefits offered by this job

Sign-On Bonus up to $25,000

Job summary

Guthrie in Binghamton, NY is seeking a Registered Nurse in Utilization Management to develop and coordinate UM processes in collaboration with stakeholders. This role suits experienced RNs eager to lead process improvements in a fast-paced healthcare setting.

The UM RN will identify patient status, support billing decisions, prepare case summaries, and provide clinical consultation. Requires NY RN license; BSN preferred with 5+ years acute care; sign-on bonus up to $25,000.

Qualifications

• Active RN license in New York is required.
• BSN preferred with 5+ years of acute care experience.
• Willingness to pursue BSN if RN has 5 years of experience.

Responsibilities

• Coordinate and facilitate correct identification of patient status.
• Complete short stay work queue reviews and track results for reporting.
• Collaborate with nursing, physicians, and billing staff on clinical questions.
• Maintain status determination tools and distribute to staff as needed.
• Prepare succinct clinical case summaries for billing status recommendations.
• Serve as a resource for RN case managers to ensure accurate patient status.
• Assist with preparation of discussion and appeal letters for denials.
• Provide clinical consultation regarding UM to providers and colleagues.
• Create reports displaying data and providing narrative analysis.
• Document and elevate UM quality and clinical care risks concerns.

Skills

Clinical coordination

Process improvement

Stakeholder collaboration

Reporting

Education

RN license (New York)

BSN preferred

Job description

About This Role

The Registered Nurse (RN) in Utilization Management (UM) is responsible for developing, coordinating, and maintaining UM processes in collaboration with various stakeholders. This role is ideal for experienced RNs looking to engage in process improvement initiatives within a fast-paced healthcare environment.

Highlights

• Pay: $37.50 - $53.06 per hour
• Location: Binghamton, NY
• Sign-On Bonus: Up To $25,000 for Qualified RNs

What You'll Do

• Coordinate and facilitate correct identification of patient status.
• Complete short stay work queue reviews and track results for reporting.
• Collaborate with nursing, physicians, and billing staff on clinical questions.
• Maintain status determination tools and distribute to staff as needed.
• Prepare succinct clinical case summaries for billing status recommendations.
• Serve as a resource for RN case managers to ensure accurate patient status.
• Assist with preparation of discussion and appeal letters for denials.
• Provide clinical consultation regarding UM to providers and colleagues.
• Create reports displaying data and providing narrative analysis.
• Document and elevate UM quality and clinical care risks concerns.

Requirements

Education

• Current RN licensure required for the state in which the employee works.

Experience

• BSN preferred with a minimum of five years’ clinical experience in an acute healthcare setting.
• RN with a minimum of five years relevant acute care experience willing to pursue a BSN may be considered.

Licenses & Certifications

• Current RN License in New York

About Guthrie

Guthrie is a leading healthcare provider committed to delivering exceptional patient care. They focus on collaboration and innovation to improve health outcomes across their communities.