Collaborates and coordinates with all members of the health care team, patient and family or significant others to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in Support of positive patient health care outcomes, Increased patient, health care team outcomes and satisfaction, Improved inpatient throughput and appropriate length of stay, Improved communication, awareness and adherence to regulatory requirements associated with utilization, Support for inappropriate level of care and decreased inpatient bed day denials, Continuity and coordination of care, Appropriate and timely authorization for level of care, Decreased denials, Appropriate reimbursement.
Minimum 3 years of clinical experience,acute care, required. Additional experience in sub acute setting, or managed care preferred. A minimum of 2 years of clinical experience with the population to be served required.Qualifications
RN - Registered Nurse Graduate of an accredited school of Nursing required. CM certificate preferred. Bachelors degree preferred.
The UM Nurse is responsible for ensuring patients are placed in the appropriate level of care and clinicals are sent to our payors timely to ensure reimbursement for the services provided and to avoid denials. The Utilization Management Nurses are responsible to ensure compliance with CMS guidelines.