RN Utilization Manager (PRN)

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

At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system.

We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nested in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.

Job Description And Position Requirements

Scheduled Weekly Hours: TBD

Summary of the Job:

The Utilization Manager is responsible to assist in the development, planning, coordination, and administration of the activities of Utilization Management. Job responsibilities include but are not limited to the following: daily review of medical records to determine appropriateness and medical necessity of admission, continued stay, use of resources, and discharge readiness. Assumes responsibilities delegated by the Department Head.

Minimum Qualifications:

• Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing.
• Five years of hospital nursing experience preferred.
• Experience in the field of Utilization Management activities highly preferred.
• Basic understanding of CPT-ICD-9 coding principles and DRG management preferred.
• Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing.
• Ability to demonstrate effective written and verbal communication skills and possess emotional and professional maturity.
• Highly organized and efficient in establishing priorities and performing tasks within specific timeframes.
• Self-motivator requiring minimal supervision.
• Views problems as a challenge and investigates alternatives which demand creativity, flexibility and the ability to work under stress.
• Responsible for maintaining strict confidentiality of all verbal & written information and documents.
• Knowledgeable in the Utilization Management review process.

Physical Demands:

Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required.

Physical Effort required:

• Constant (67%-100%) – seeing
• Frequently (34%-66%) - handling/feeling, talking, hearing
• Occasionally (1%-33%) – lifting, carrying, pushing/pulling, stooping, crouching, reaching

Contact Information:

Jennifer Saint, HR Talent Partner

Talent Acquisition - Human Resources

EMPLOYMENT

Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.

EQUAL OPPORTUNITY EMPLOYER

St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.