Utilization Management - Case Manager II (RN)

About the role

The Utilization Management Case Manager (UMCM) assesses patients for appropriate levels of care, utilizing professional nursing and critical thinking skills. They maintain a strong knowledge base of clinical criteria, UR requirements, and identify pertinent clinical information to support admissions and stays.

Responsibilities

• Collaborate with floor ICM staff, Revenue Cycle, involved physicians, and Physician Advisors (PA) to obtain second-level review/approval for denials or transitions.
• Evaluate and optimize utilization across patient populations to meet organizational strategic goals.
• Mentor and precept new staff members.

Requirements

• Bachelor of Science in Nursing (BSN) from an accredited school of nursing.
• Three (3) years of utilization review experience, including at least three (3) years in an acute care setting.
• Basic experience with PC/computers (word processing).
• Active Case Management Certification (CCM or ACM) or within one (1) year of hire.
• Membership in relevant CM/UM organizations.
• Ability to manage multiple tasks and adjust priorities.
• Solid clinical assessment, critical thinking, decision-making, and organizational skills.
• Effective communication skills, both verbal and written.
• Strong interpersonal skills and collaborative abilities.
• Knowledge of relevant federal and state utilization review and appeal requirements.

Qualifications

• FL RN license.

Skills

• Utilization management expertise.
• Collaborative problem-solving.
• Effective communication.
• Organizational skills.

Benefits

• Paid Time Off (PTO).
• Tuition Reimbursement.
• Discounted medical, prescription, dental, vision plans.
• Flexible Spending Accounts (pre-tax dollars).
• Life Insurance.
• Disability Insurance.
• Retail savings Plan: 403b.
• Discounted child care & before and after school programs and summer camps.
• Free parking on campus.
• Discounted dining.
• Wellness screening and programs.
• Referral programs.
• Advancement and growth opportunities.

Pay

Details not specified.

Schedule

Details not specified.