Performs a review of the clinical assessment for medical necessity for all hospitalized patients using utilization review criteria, technologies and tools to verify appropriate level of care while promoting fiscal responsibility. Identifies, suggests and coordinates, cost-effective alternatives when appropriate to the patient’s condition. Supports provider decision-making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes.
Located in Seattle, WA, Virginia Mason is an internationally recognized leader in the continuous improvement of health care. With an extensive list of awards and distinctions that includes our recognition as Top Hospital of the Decade by The Leapfrog Group, Virginia Mason offers you the opportunity to partner with exceptionally talented peers at every level.
You will contribute to the strength of our Team Medicine approach to collaborative medicine and benefit from the changes enacted through our Virginia Mason Production System, a model that has transformed health care by providing patients with easier access to care, reducing errors, and continuously innovating patient safety and quality that has been adopted by other organizations here and abroad. Join us, and find out how many ways Virginia Mason offers you the chance to focus on what really matters - our patients.
Bachelors degree and three years of professional nursing experience in a hospital setting required. Experience in utilization review: Interqual or MCG knowledge/use preferred. Knowledge of core insurance coverage guidelines and financial principles are also preferred. Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care. An understanding of variable payor rules and regulations is also required.
Just as Virginia Mason is dedicated to improving the lives of our patients and our community, we are equally dedicated to your professional and personal success. With a wide range of perks that includes comprehensive compensation and benefits, continuing education and support, and the opportunity to live in one of the most livable cities in the country, you will find that an opportunity with Team Medicine is one worth taking.
We are an equal opportunity/affirmative action employer