Registered Nurse -Utilization Management Emergency Department

About the role

On-site day shifts. Emergency department experience preferred. The Registered Nurse Utilization Review (UR), Clinical Care Manager (CCM) actively manages the utilization review process and patient progression from Admission to Discharge, serving as the principal liaison between emergency services, surgical services, nursing, finance, physicians, and medical records. Responsible for coordinating safe and appropriate discharge plans within their service area.

Responsibilities

• Completes initial and follow-up case reviews on all patients as dictated by payer and status.
• Uses Interqual and Indicia/MCG software and Physician Advisors to determine appropriate patient status/level of care and ensure timely transition of care from admission to discharge.
• Follows Medicare guidelines and industry standards to ensure the proper patient class is assigned.
• Leads daily SNAP huddles and collaborates with unit staff and support team (RN, Physician/Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to progress each patient’s care toward discharge.
• Performs Initial Stay reviews.
• Ensures quality nursing care is rendered in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing and Clinical Service standards of care and practice.
• Maintains current knowledge of basic healthcare economics, trends, and reimbursement methodologies and applies knowledge to daily practice.
• Recognizes situations that require immediate intervention and continues to develop professionally to provide appropriate care to each patient.

Requirements

• Graduation from an accredited school of nursing and current licensure in the State of New York.
• Bachelor’s degree in nursing preferred, with one to two years of progressive experience in the field.
• Strong clinical skills, leadership qualities, and actively working toward an advanced degree.
• Specialty credentialing and educational degree according to clinical nursing practice specialty area preferred.
• Maintains all licensures and certifications according to NYS regulations and specialty area requirements.
• Participates in continuing education and updates and maintains knowledge and skills related to specific areas of expertise.

Benefits

• Comprehensive benefit packages including medical, dental, vision, paid time off, 403B, and education assistance.
• Strong education program, generous tuition allowance, and clinical ladder incentives.
• Job share opportunities to enhance satisfaction and growth.
• Scheduling options to balance work/life/school and recreational calendars.

Pay

$36.25 – $53.70 per hour. Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.