*Highland Hospital is seeking a Full Time Utilization Management Nurse to join its team. This is an exempt level job with hours of Monday - Friday, Days. The UM team is currently doing a mix of virtual/from home work.Some duties include but are not limited to:The UM RN is responsible for the review of clinical documentation utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided. The UM RN is also responsible for reviewing outcome trends and patterns to identify educational opportunities and performance improvement processes across the health care continuum. The UM RN works collaboratively with medical providers, Social Work, Health Information Management (HIM), Financial Counseling, Patient Financial Services (PFS), insurance payers, and patients. The role requires strong communication and critical thinking skills.
- Education: Fulfills the educational requirements to be a licensed RN in NYS.
- Experience: Utilization Management experience and 3-5 years clinical experience preferred.
- License/Certification Required: current NYS license-Registered Nurse
- Skills: Proficiency in Microsoft Office, spreadsheet creation and management, data entry and reporting. Ability to demonstrate Highland Promise Standards and ICARE Values.
- Knowledge/proficiency in InterQual screening criteria preferred.
- Knowledge of clinical terminology.
- Ability to read and analyze all information in an electronic health record.
- Clinical knowledge (anatomy and physiology, pathophysiology, and pharmacology)
- Knowledge of healthcare regulations, including reimbursement and documentation requirements.
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