RN Utilization Review Specialist: Elevate Care Coordination

Corewell Health; United States; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Comprehensive benefits package

On-demand pay

Discounts directory

Job summary

Corewell Health is seeking an experienced RN for Utilization Management to assess clinical information, coordinate case management for complex patient populations, and ensure regulatory compliance. You will collaborate with physicians, social workers, and other hospital staff to optimize admission decisions and levels of care.

Requirements include a BSN or equivalent, an active Michigan RN license, and 5 years of related experience in acute care or behavioral health with UM, discharge planning,

Qualifications

• Required Bachelor's Degree or equivalent Nursing or a health care related field.
• 2 years of relevant experience acute care, clinical nursing, preferably multiple clinical settings, or related experience
• 5 years of relevant experience in acute care, multiple clinical settings or behavioral health with utilization management, discharge planning, designing patient-centered care plans
• Registered Nurse (RN) - State of Michigan Upon Hire required

Responsibilities

• Assesses and interprets clinical information and assists in case management of complex patient population, through use of independent judgment, mature problem solving skills, and guidelines for appropriateness of acute care setting upon admission and continued stay.
• Ensure documentation and processes are consistent with regulatory standards
• Communicates with physicians, medical social workers, and other hospital personnel concerning change in level of care on the medically complex patient population. Makes recommendations and discusses alternatives. Provides financial/DRG, UM, health information to other facilitation team members for work prioritization. Communicates and collaborates with physicians and members of the team to ensure continuity and coordination of services.
• Documents any instances where services were delayed, inappropriate, refused, complicated, etc. for resource management functions.
• Identifies quality indicators to facilitate process improvement and physician education.
• Ensure members are authorized for the most appropriate level of care and services based on internal and external guidelines.
• Collaborates with Medical Directors

Job description

Corewell Health is seeking an experienced RN for Utilization Management to assess clinical information, coordinate case management for complex patient populations, and ensure regulatory compliance. You will collaborate with physicians, social workers, and other hospital staff to optimize admission decisions and levels of care.

Requirements include a BSN or equivalent, an active Michigan RN license, and 5 years of related experience in acute care or behavioral health with UM, discharge planning,