RN Utilization Manager — Care Optimization Leader

St. Tammany Health System; Covington (LA); On-site; USD 85,000 - 105,000; Full time

Job summary

St. Tammany Health System in Covington, LA seeks an Utilization Manager to assist in developing and coordinating Utilization Management activities. The role involves daily medical record reviews to ensure admission appropriateness and discharge readiness.

The position requires an RN license in Louisiana, 5 years of hospital nursing experience, and evidence of strong communication and organizational skills. Knowledge of CPT/ICD-9 coding and DRG management is preferred.

Qualifications

• RN licensure in Louisiana and active license.
• 5 years hospital nursing experience preferred.
• Experience in Utilization Management preferred.
• Knowledge of CPT/ICD-9 coding and DRG management preferred.
• Strong written and verbal communication skills.
• Highly organized with priorities and time management.
• Self-motivated with minimal supervision.
• Maintains confidentiality of information.
• Knowledge of Utilization Management review process.

Responsibilities

• Assist in development, planning, coordination, and administration of Utilization Management activities.
• Daily review of medical records to determine appropriateness and medical necessity.
• Assess admission, continued stay, use of resources, and discharge readiness.
• Assume responsibilities delegated by the Department Head.

Skills

Communication skills

Organizational skills

Self-motivation

Confidentiality

Written and verbal communication

Ability to work under stress

Education

RN licensure (LA BON)

Tools

CPT/ICD-9 coding

DRG management

Job description

St. Tammany Health System in Covington, LA seeks an Utilization Manager to assist in developing and coordinating Utilization Management activities. The role involves daily medical record reviews to ensure admission appropriateness and discharge readiness.

The position requires an RN license in Louisiana, 5 years of hospital nursing experience, and evidence of strong communication and organizational skills. Knowledge of CPT/ICD-9 coding and DRG management is preferred.