Utilization Management Spec RN

Position Summary

The Utilization Management (UM) Principal Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility Principal UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient’s hospital stay. The Principal facilitates Utilization Review (UR) compliance, and optimal reimbursement through oversight of their assigned licensed facility’s UR process including: accurate admission and continued stay reviews based on CMS regulations, UM criteria, certification and/or authorization, and complete chart documentation.

This position serves as a resource for Utilization Management clinical and support staff. This position assists with providing guidance on troubleshooting with complex cases and also assists with daily assignments of UM clinical and support staff to ensure patients are receiving timely and accurate reviews. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management.

Requirements

• Bachelor’s degree in Nursing, or obtained within three years from the initial date of hire
• Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
• Currently licensed as a nurse (State of Washington)
• Five years of clinical experience required; utilization management and/or insurance industry experience preferred

Why MultiCare?

• Rooted in the local community
• Partnering with patients, families and neighbors across the Pacific Northwest for more than 140 years
• Growth and education
• Competitive tuition assistance, award-winning residencies, fellowships and career development to invest in you
• Well-being and support
• Generous PTO, Code Lavender and Employee Assistance Programs to help you maintain balance and feel cared in your work and life
• Living our values
• Respect, integrity, kindness and collaboration guide how we care for patients, communities and each other
• Belonging for all
• Resource Groups and outreach programs help ensure every team member feels safe, seen, heard and valued
• Pacific Northwest lifestyle
• Work and live where natural beauty, adventure and strong community connections are part of everyday life

Pay and Benefits

• Competitive salary
• Medical, dental and retirement benefits
• Paid time off