Utilization Management Specialist - Utilization Management

Penn State Health; Hershey (PA); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to join their team at a prestigious medical center. This role involves reviewing clinical documentation in the Electronic Medical Record (EMR) to ensure compliance with national standards and regulations. The ideal candidate will possess strong problem-solving skills and the ability to manage complex situations effectively. With a commitment to professional development and a focus on compassionate care, this position offers an opportunity to make a significant impact in the community while enjoying a supportive work environment and exceptional benefits.

Benefits

Employee Wellness Programs

Fitness Discounts

Generous Paid Time Off

Paid Parental Leave

Retirement Plans

Life Insurance

Tuition Reimbursement

Employee Recognition Program

Concierge Service

Qualifications

• 3 years advanced clinical experience in a hospital setting required.
• Currently licensed to practice as a Registered Nurse.

Responsibilities

• Review clinical documentation in the EMR against evidence-based criteria.
• Maintain compliance with CMS Conditions of Participation.

Skills

Problem Solving

Conflict Management

Organizational Skills

Communication Skills

Independence

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

Electronic Medical Record (EMR)

Job description

Penn State Health - Hershey Medical Center

Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p
Recruiter Contact: Taryn Blydenburgh at [e-mail]

SUMMARY OF POSITION:

Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.

MINIMUM QUALIFICATIONS:

1. Bachelors Degree in Nursing or Masters Degree in Nursing required
2. 3 years advanced clinical experience in a hospital setting required.
3. Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license through the interstate Nurse Licensure Compact.
4. Demonstrated ability to problem solve complex, multidimensional situations required.
5. Ability to successfully manage conflict and negotiate "win-win" solutions required.
6. Strong organizational, task prioritization and delegation skills required.
7. Strong oral and written communication skills required.
8. Ability to work independently required.

PREFERED QUALIFICATIONS:

• Financial Counseling experience preferred.

WHY PENN STATE HEALTH?

Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.

Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:

• Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).
• Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.
• Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.
• Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.
• Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.

WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?

Penn State Hershey Medical Center is Central Pennsylvania's only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.

YOU TAKE CARE OF THEM. WE'LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence – that’s Penn State Health. But what makes our healthcare award-winning? That’s all you.

This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

Union: SEIU Healthcare Pennsylvania