Top 5196 Rn Utilization Manager Jobs

RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Senior Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
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Mayo Clinic —Phoenix, AZ
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RN Clinical Reimbursement Manager
Keswick Multicare Inc —Baltimore, MD
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- Full-time
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- AD&D insurance
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7d
Utilization Management Clinician I
Community Health Plan of Washington —Seattle, WA
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Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
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Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
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10d
Claims - Care Manager, RN, Claims
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Oncology Prior Authorization Case Manager, Non-RN - Remote
University of Miami —Miami, FL
- Full-time
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- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
RN Quality Educator
UR Medicine Home Care —Webster, NY
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- CPR Certification
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RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
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Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
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Patient Care Manager 3D/3E/Burn
Arkansas Children's Hospital —Little Rock, AR
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Site Manager (Registered Nurse)
Primary Care of Southwest Georgia —Quitman, GA
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- Background check
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RN/LPN Unit Manager
Confidential —Ocean County, NJ
- Full-time
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- BLS Certification
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- Dental insurance
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Health Home Registered Nurse Case Manager
Enliven Home Health —Hartford County, CT
- Full-time
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Assistant Nurse Manager
Centennial Surgery Center —Voorhees, NJ
- $60 - $63 an hour
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RN Acute Case Manager - System Care Management - Full Time Day
The Guthrie Clinic —Sayre, PA
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Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Georgia
- On call
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- Travel
- Paid parental leave
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Advanced Practice Nurse
Alina Lodge —Blairstown, NJ
- $165,000 a year
- Full-time
- Background check
- 18 years or older
- CPR Certification
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RN Utilization Management

MedStar Health -
Washington, DC

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Job Details

Full-time
$89,065 - $162,801 a year

Benefits

Vision insurance

Qualifications

RN License
Utilization management

Full Job Description

About this Job:

General Summary of Position
The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Acts as a liaison to MedStar Family Choice (MFC) contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups etc. as assigned. Provides input completes assignments and shares new findings with other staff. Participates in meetings and on committees and represents the department and MFC in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
Identifies inpatients requiring additional services and initiates care with appropriate providers. Demonstrates emphasis on quality patient care during the pre-admission and/or concurrent review process. Authorizes services according to MedStar Family Choice policy.
Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-authorization requests inpatient stays and retrospective reviews.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policy.
Monitors utilization of all services for fraud and abuse.
Performs pre-authorization and pharmacy reviews and documents in PBMÆs system when assigned.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Performs telephonic inpatient utilization review services; on-site review as indicated. Process includes: assessment planning coordinating and implementation. Monitors for timely provision of services. Assists hospital case management staff with discharge planning as applicable.
Makes referrals to Case Management as needed.
Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications per policy NCQA standards/guidelines and District of Columbia Contract.
Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.

Minimal Qualifications
Education

Valid RN license in the District of Columbia; or Maryland required and
Bachelor's degree preferred

Experience

1-2 years Recent utilization experience required and
1-2 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and
CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred

Knowledge Skills and Abilities

Proficient computer skills to enter and retrieve data.
Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
Knowledge of InterQual guidelines preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

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Refine Your Search

Rn Utilization Manager jobs

RN Utilization Management

Senior Manager, Utilization Management

Nurse Manager - Utilization Management

RN Clinical Reimbursement Manager

Utilization Management Clinician I

Concurrent Utilization Review Nurse, RN

Denials & Appeals Administrator (RN)

Claims - Care Manager, RN, Claims

Oncology Prior Authorization Case Manager, Non-RN - Remote

RN Quality Educator

RN Clinical Manager

Patient Care Manager - Floater (RN)

Patient Care Manager 3D/3E/Burn

Site Manager (Registered Nurse)

RN/LPN Unit Manager

Health Home Registered Nurse Case Manager

Assistant Nurse Manager

RN Acute Case Manager - System Care Management - Full Time Day

Market Physician Executive (MPE) - Float

Advanced Practice Nurse

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