Utilization Management RN: Optimize Patient Care

Thomas Jefferson University Hospitals, Inc.; Jefferson Center (PA); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Job summary

Thomas Jefferson University Hospitals, Inc. seeks a skilled RN with case management experience to perform utilization management, determine patient status, and coordinate inpatient care. You will engage with Physician Advisor and multidisciplinary teams to ensure compliant, efficient care delivery.

The role requires knowledge of InterQual/MCG criteria, discharge planning, and working with managed care payors. Strong communication and documentation in EHRs are essential for success.

Qualifications

• Bachelor’s degree in Nursing required.
• 3 years of case management, discharge planning or utilization management experience.
• Knowledge of managed care, governmental and third party payors reimbursement.

Responsibilities

• Apply medical necessity criteria to determine patient status for utilization management.
• Conduct denial and appeal activities for inpatient care.
• Collaborate with multidisciplinary team to coordinate care and communicate with physicians and care teams.

Skills

Case management

Communication skills

Team collaboration

Documentation in EHR

InterQual criteria

MCG criteria

Discharge planning

Managed care knowledge

Regulatory knowledge

Education

Bachelor's Degree in Nursing

Tools

InterQual

EHR/EMR systems

Job description

Thomas Jefferson University Hospitals, Inc. seeks a skilled RN with case management experience to perform utilization management, determine patient status, and coordinate inpatient care. You will engage with Physician Advisor and multidisciplinary teams to ensure compliant, efficient care delivery.

The role requires knowledge of InterQual/MCG criteria, discharge planning, and working with managed care payors. Strong communication and documentation in EHRs are essential for success.