RN Utilization Manager (PRN)

St. Tammany Parish Hospital; Wheeler Heights (OR); On-site; USD 85,000 - 110,000; Full time

Job summary

St. Tammany Health System seeks an Utilization Manager to assist in planning, coordinating, and administering Utilization Management activities.

Responsibilities include daily chart reviews for medical necessity, coordinating admissions and discharges, and supporting the Department Head. Minimum qualifications include an accredited nursing degree with active RN licensure, at least five years in hospital nursing, and preferred experience in Utilization Management and DRG/CPT-ICD-9 knowledge.

Qualifications

• Graduate of accredited nursing program with active RN license.
• 5 years hospital nursing experience preferred.
• Experience in Utilization Management preferred.
• Knowledge of CPT-ICD-9 coding and DRG management preferred.

Responsibilities

• Daily review of medical records to assess appropriateness and medical necessity.
• Coordinate admission, continued stay, resource use, and discharge readiness.
• Maintain confidentiality of all information and assist department head.

Skills

RN/Licensed Nurse

Utilization Management

CPT-ICD-9 coding

DRG management

Communication skills

Education

Registered Nurse degree

Tools

CPT-ICD-9 coding principles

DRG management

Job description

JOB DESCRIPTION AND POSITION REQUIREMENTS

Scheduled Weekly Hours: TBD

Work Shift: (Usually 6 P.M. - 11 P.M.)

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.

St. Tammany Health System is a full-service acute care facility that delivers today’s life-improving procedures with the latest technology, highest quality and the utmost care to area residents. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, the St. Tammany Health System delivers the very latest technology, the most accomplished specialists and highly personalized, caring staff to ensure patients and their families receive world-class healthcare close to home.

St. Tammany Health System is an independent service district in a clinically integrated partnership with Ochsner Health System. Together, the two organizations focus on aligning their healthcare offerings to best serve patients and families in west St. Tammany Parish and surrounding areas.