Utilization Management RN - Optimize Care & Denials

LE01 Valley Children's Hospital; United States; On-site; USD 78,922 - 112,577; Full time

Job summary

LE01 Valley Children's Hospital is looking for a Utilization Management Nurse to support the case management department. Responsibilities include daily screening of patient admissions, denial management, and communication with payors.

The ideal candidate should have an Associate's Degree in Nursing, an RN License, and at least three years of acute care experience. Compensation ranges from $57.29 to $81.72 per hour, with a work schedule of 36 hours per week.

Qualifications

• Minimum three years of full-time equivalent RN experience in an acute care hospital.
• Registered Nurse (RN) License required.
• Pediatric experience preferred.

Responsibilities

• Daily screening of patient admission relative to specified criteria.
• Active involvement in denial management.
• Act as a resource to staff regarding clinical criteria.
• Communicate with payors to address concerns.
• Provide support to the Utilization Nurse Program Coordinator.

Skills

Knowledge of utilization management regulations

Excellent organizational and communication skills

Ability to work independently

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing or related field

Tools

Proficiency with word processing software

Proficiency with spreadsheets

Proficiency with database software

Job description

LE01 Valley Children's Hospital is looking for a Utilization Management Nurse to support the case management department. Responsibilities include daily screening of patient admissions, denial management, and communication with payors.

The ideal candidate should have an Associate's Degree in Nursing, an RN License, and at least three years of acute care experience. Compensation ranges from $57.29 to $81.72 per hour, with a work schedule of 36 hours per week.