Utilization Management RN

North Memorial Medical Center; Robbinsdale (MN); Hybrid; USD 55,000 - 83,000; Full time

Benefits offered by this job

Health insurance

401k Retirement Match or Pension Plan

Generous Paid Time Off (PTO) Plans

Adoption Reimbursement up to $3000 per

Child Care Discount Program with New

Education/Tuition Reimbursement

24/7 Fitness Center Access

Job summary

North Memorial Health is seeking an experienced Utilization Management RN to support medical staff at North Memorial Health and Maple Grove Hospital. You will assess admission necessity, aid in care coordination, and ensure quality outcomes through effective resource management.

This role requires RN licensure in MN, 3–5 years acute care and 1–2 years utilization review, with strong communication and conflict-resolution skills. Hybrid remote work eligible for MN/WI residents.

Qualifications

• Bachelor's degree in nursing required.
• 3–5 years of acute care nursing experience required.
• 1–2 years of utilization review experience preferred.
• One year of direct case management experience required.
• Hospital case management and utilization management experience required.
• Knowledge of Medicare rules and regulations.
• Strong communication skills with ability to express ideas clearly.
• Ability to deal with conflict in a positive manner.

Responsibilities

• Assess documented medical necessity to assist admission status.
• Provide clinically based information to support care coordination.
• Support quality clinical outcomes and resource management.
• Collaborate with nursing, social services, therapies, and other teams.
• Know disease trajectories, treatment plans, and length of stay.

Skills

Acute care nursing

Utilization review

Case management

Nursing theory

Medicare rules

Communication skills

Conflict resolution

Education

Bachelor's Degree in Nursing

Job description

At North Memorial Health, you’re part of an inclusive health team that is rooted in our values: Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North’s culture which is designed to actively support each team member’s wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health.

Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women’s Choice Award Best Hospitals list.

Benefits the North Way!

• Health & Welfare Benefit Packages
• 401k Retirement Match or Pension Plan, based on workgroup eligibility
• Generous Paid Time Off (PTO) Plans
• Adoption Reimbursement up to $3000 per child
• Child Care Discount Program with New Horizon 10% off weekly childcare tuition
• Education/Tuition Reimbursement
• 24/7 Fitness Center Access for all benefit eligible team members

Commitment to Diversity, Equity & Inclusion

At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.

About this position

The Utilization Management RN, under the supervision of the Utilization Management Manager, acts as a support resource to the Medical Staff of North Memorial Health (NMH) and Maple Grove Hospital (MGH) in relationship to clinical documentation of admitted customers. The UM RN assess the documented medical necessity of each bedded patient to assist the MD as needed to determine an appropriate admission status. They provide clinically based information to assist with care coordination and support the delivery of quality customer care as efficiently as possible. The RN has accountability for assisting in ensuring quality clinical outcomes, and appropriate resource management related to admission, readmission, length of stay, extended stay, avoidable days and discharge planning. They work with the medical and care teams (nursing, social services, therapies, and ancillary departments) to ensure the customer is receiving the right care, at the right level across the continuum. Additionally, they know the disease, trajectory of illness, treatment plan, standard of care for the diagnosis, expected outcome, and Length of Stay (LOS) for the case type. They work with all admissions (bedded customers) excluding any customers in the Emergency Department Finally, they UM RN actively and consistently demonstrates the mission, vision, values and guiding principles of North Memorial Health.

Requirements

Education

• Bachelor's Degree from an accredited school of nursing required.

Experience

• Three (3) to five years of previous acute care nursing experience required.
• 1-2 years of direct utilization review experience preferred.
• One (1) year of direct case management experience required.
• Hospital case management and utilization management experience required.
• Knowledge of nursing theory and practice and primary care principles and practices.
• Knowledge of Medicare rules and regulations.
• Knowledge of current case management principles, utilization management, length of stay management, and/or transition/discharge planning.
• Knowledge of current nursing principles, techniques and procedures.
• Demonstrated ability to deal with conflict in a positive manner. Has an awareness of, responds to, and considers the needs, feelings and capabilities of others.
• Strong communication skills with demonstrated ability to express ideas and information clearly and concisely in a manner appropriate to the audience.

Licensure/Certification

Current licensure and registration as an RN in the State of MN. - State Requirement

North Memorial Health System is dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role, but your past experience doesn’t perfectly align with every qualification listed, we encourage you to apply anyway. You may still be the right candidate for this or other roles.

Work Group: Non Contract

Hourspertwoweekpayperiod: 80

Shift: Days 8 hours

Call Requirement: None

Remote or On-site:Hybrid Remote- Must live in MN or WI

FLSA Status: Exempt

Benefit Eligibility: Health insurance benefits are available for this position. North Memorial Health offers multiple health plans based on work group eligibility.

Salary Range:N23 ($39.83 - $59.74), based on experience

Shift Differential: Compensation may include shift differential pay depending on the position and shift worked.

STI Bonus Eligible: False

Employment Sponsorship:Applicants must be currently authorized to work in the United States on a full-time basis. Work visa sponsorship is not available for this position

North Memorial Health is an equal employment and affirmative action employer. North Memorial Health does not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, disability, genetic information, marital status, veteran status, sexual orientation, gender identity, creed, status with respect to public assistance, or other protected class status. North Memorial Health provides reasonable accommodation to disabled applicants and employees and takes affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to protected class status. If you believe that you have been treated in a way that does not conform to these statements, please contact our HR Service Center: [e-mail]. If you need a reasonable accommodation, due to a disability, or to assist with the application process, please contact our HR Service Center: [e-mail].

INSPECTION OF AAP

North Memorial Health is a Federal government contractor or subcontractor.
As a part of our obligations under law, we must develop a written AAP for Individuals with Disabilities and Protected Veterans, as specified by law (AAP).
This AAP is available for inspection by applicants and employees in the Human Resources Office during normal business hours.
Link to Policy

North Memorial Health

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