Utilization Management Rn

Wage Range: $44.31 - $70.90 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity

As an organization our staff our proud to be working for an organization that has been named:

• One America’s 50 best Hospitals, three years in a row by Healthgrades. EvergreenHealth ranks in the top 1% of nearly 4,500 hospitals nationwide.
• In 2023 EvergreenHealth was one of two hospitals that received the Patient Safety Excellence Award throughout the states of WA, ID, OR, MT, and Alaska

Job Summary:
Assignment will cover med-surg UM. Preference for those with prior cardiology experience.
The RN in our Care Management department specializes in assessing hospital admissions for status per defined criteria and reviews for appropriate utilization of resources. Ensures continuity and coordination of care for patients before, during and after hospitalization, and ensures that payer conditions are met.

• In conjunction with the interdisciplinary team supervises progress and recommends appropriate clinical interventions to nursing staff and attending physicians, ensuring CMS guidelines are met.
• In conjunction with the interdisciplinary team ensures that patients and families have access to resources for post-hospital care needs.
• Monitors patients’ medical progress, identifies and addresses patient needs/gaps in service as they move through the system, and obtains authorization for discharge planning as appropriate.
• Takes action to correct variances in length of stay by following up with physicians and payers as needed.
• Provides utilization reviews, meeting all time requirements and addresses the discharge appeal process in collaboration with the physician, Dir/Mgr and/or Social Worker.

License, Certification, Education or Experience:
REQUIRED for the position:

• Current State of Washington RN license
• Bachelors of Science degree in Nursing or be actively pursuing a degree in Nursing
• Three (3) years of experience as an RN with a combination of acute care and/or case management experience.
• Current American Heart Association Healthcare Provider BLS certification by date of hire.
• Knowledge of the healthcare financial environment, reimbursement and levels of care.
• Knowledge of community resources and how to access them effectively and efficiently.
• Interpersonal skills necessary to lead and coordinate an interdisciplinary team and deal effectively with patients and families from a variety of backgrounds and with varied emotional and medical needs.
• Age-appropriate developmental assessment skills.
• Excellent communication skills to ensure and deliver safe patient care and to provide a legal record of this care.
• Accountability for professional nursing practice, commitment to patient care and commitment to uphold the Patient Bill of Rights.

DESIRED for the position:

• Master’s degree in Nursing or other experience and /or educational preparation that would provide the foundation for Nursing Case Management

• Washington Paid Sick Leave (WPSL)
• Participation in 457(b) retirement plan
• Free parking
• Cafeteria & Gift Shop Discount

NUR321

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