Utilization Management Nurse (Hybrid)

A Brief Overview

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 outcomesIncreased 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 management Support for appropriate 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

What You Will Do

• Performs timely and accurate admission and continued stay review in accordance with department policy to ensure efficient use of hospital resources, timely discharge and optimal, appropriate reimbursement (includes communication with internal and external customers).
• Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to promote timely and effective communication, completion of workflow and services with regard to level of care decisions and payor decisions regarding continued stay.
• Documents review activity, including but not limited to, application of criteria or policy as appropriate, clinical review to submit to insurance providers, initiation of registration changes when appropriate, outcomes and cost savings in a manner consistent with department requirements.
• Meets department productivity and quality standards.

Additional Responsibilities

Performs other duties as assigned.

Complies with all policies and standards.

For specific duties and responsibilities, refer to documentation provided by the department during orientation.

Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.