Hennepin County Medical Center
Staff Nurse - Utilization Review (Float)
Hennepin County Medical Center, Minneapolis, Minnesota, United States, 55400
Overview
Hennepin Healthcare is an integrated system of care including HCMC, a Level I Adult and Level I Pediatric Trauma Center and acute care hospital, and a clinic system. The system operates a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in Minneapolis and surrounding communities. The organization includes a large psychiatric program, home care, a research institute, philanthropic foundation, and Hennepin EMS. Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieving optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and to diversity, equity, inclusion, and belonging. Summary
We are currently seeking a
Staff Nurse
to join our Utilization Management department in a
FLOAT
assignment to support Inpatient, Psych and the Emergency Departments. This position is a
0.8 FTE
(8 shifts/pay period), with 8-hour shifts, rotating Days/Evenings (8 am–4:30 pm / 4:30 pm–1 am) and up to every other weekend. Note: current weekend assignment is typically every 2–8 weeks but is subject to change based on staffing needs and may require up to every other weekend coverage. Specific Responsibilities
The Utilization Review (UR) Registered Nurse evaluates medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. The RN reviews inpatient and outpatient medical records to determine admissions appropriateness, continued stays, and level of care using established criteria and guidelines (e.g., InterQual, MCG). The role collaborates with healthcare providers, patients, payers, and internal departments to ensure quality care while optimizing resource utilization and controlling costs. Assessment:
Collects, reviews, and documents clinical data relevant to utilization management, including patient status, treatment plans, and healthcare utilization. Applies nationally recognized criteria (e.g., InterQual, MCG) to assess the appropriateness of services. Outcomes Identification:
Identifies expected outcomes related to care transitions, resource use, and reimbursement to optimize patient health outcomes and reduce unnecessary utilization. Planning:
Develops a utilization management plan by coordinating with clinical teams, payers, and discharge planners to support timely care progression and appropriate resource use. Implementation:
Implements review processes to evaluate necessity and efficiency of services. Initiates communication with physicians and payers to resolve authorization issues and prevent delays in care. Evaluation:
Continuously evaluates the appropriateness of hospital admissions, continued stays, and treatment plans in accordance with payer guidelines and evidence-based practice. Quality of Practice:
Promotes quality through evidence-based utilization review processes and contributes to performance improvement initiatives. Education:
Maintains current knowledge in UR/UM practices, payer requirements, clinical guidelines, and regulations affecting utilization management. Professional Practice:
Evaluates personal practice against professional standards, licensing requirements, and Hennepin Healthcare policies. Collegiality:
Collaborates with nursing, providers, case management, finance, and payer representatives; supports team education and professional development. Collaboration:
Uses relationship-based care to collaborate with care teams, patients, families, and external entities to facilitate effective care coordination and appropriate resource utilization. Ethics:
Applies ethical decision-making in authorization issues, appeals, and coverage decisions; advocates for patient needs while balancing organizational goals and payer requirements. Evidence-Based Nursing Practice and Nursing Research:
Applies evidence-based criteria for utilization review decisions and supports data collection and reporting to improve outcomes. Resource Utilization:
Considers safety, effectiveness, cost, and legal compliance when recommending levels of care or authorizations; ensures documentation supports accurate coding, billing, and compliance. Leadership:
Demonstrates leadership through decision-making, multidisciplinary communication, and proactive problem-solving related to authorization and utilization challenges. Self-Evaluation:
Reviews and reflects on own practice relative to guidelines, regulations, and departmental goals. Safe Practice:
Participates in maintaining a safe, efficient, and regulatory-compliant work environment; adheres to Hennepin Healthcare protocols and confidentiality standards. Provide Education and Mentorship:
Demonstrates knowledge of adult learning principles and promotes the HHS Nursing Vision and Practice Model. Qualifications
Minimum Qualifications:
1 year of recent
utilization review, utilization management or care coordination
nursing experience. Preferred Qualifications:
1 year of recent ED or Psych UR/UM nursing experience preferred; Bachelor’s degree in nursing; Certification in area of clinical specialty; minimum 2 years of clinical experience (e.g., med/surg, ICU, ED, or case management); strong understanding of UR/UM principles; familiarity with InterQual, MCG, or similar tools; excellent critical thinking, communication, and documentation skills; proficiency with EMRs and healthcare documentation systems; BSN preferred; advancement in academic education discussed during performance review. License/Certifications:
Possession of a valid Minnesota RN license; some positions may require specialized certifications. Additional Information
You’ve made the right choice in considering Hennepin Healthcare for your employment. We offer a wealth of opportunities to make an impact in patients’ lives and provide Equal Employment Opportunities to current and prospective employees. Offers of employment are conditional and contingent upon successful clearance of background checks and pre-employment requirements. Total Rewards Package: Competitive pay based on skills, licensure/certifications, education, experience, and internal equity. Comprehensive benefits including Medical, Dental, Vision, Life, Short and Long-term Disability, Retirement Funds, Paid Time Off, Tuition reimbursement, and license/certification reimbursement (Available only for benefit eligible positions). For a complete list of benefits, visit our career site. Department: Utilization Management
Primary Location: MN-Minneapolis-Downtown Campus
Standard Hours/FTE Status: FTE = 0.80 (64 hours per pay period)
Shift Detail: Day, Evening, Every Other Weekend
Employee Status: Regular
Eligible for Benefits: Yes
Union/Non Union: Union
Min / Max: $36.70 / $69.38
Job Posting: Oct-01-2025 #J-18808-Ljbffr
Hennepin Healthcare is an integrated system of care including HCMC, a Level I Adult and Level I Pediatric Trauma Center and acute care hospital, and a clinic system. The system operates a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in Minneapolis and surrounding communities. The organization includes a large psychiatric program, home care, a research institute, philanthropic foundation, and Hennepin EMS. Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieving optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and to diversity, equity, inclusion, and belonging. Summary
We are currently seeking a
Staff Nurse
to join our Utilization Management department in a
FLOAT
assignment to support Inpatient, Psych and the Emergency Departments. This position is a
0.8 FTE
(8 shifts/pay period), with 8-hour shifts, rotating Days/Evenings (8 am–4:30 pm / 4:30 pm–1 am) and up to every other weekend. Note: current weekend assignment is typically every 2–8 weeks but is subject to change based on staffing needs and may require up to every other weekend coverage. Specific Responsibilities
The Utilization Review (UR) Registered Nurse evaluates medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. The RN reviews inpatient and outpatient medical records to determine admissions appropriateness, continued stays, and level of care using established criteria and guidelines (e.g., InterQual, MCG). The role collaborates with healthcare providers, patients, payers, and internal departments to ensure quality care while optimizing resource utilization and controlling costs. Assessment:
Collects, reviews, and documents clinical data relevant to utilization management, including patient status, treatment plans, and healthcare utilization. Applies nationally recognized criteria (e.g., InterQual, MCG) to assess the appropriateness of services. Outcomes Identification:
Identifies expected outcomes related to care transitions, resource use, and reimbursement to optimize patient health outcomes and reduce unnecessary utilization. Planning:
Develops a utilization management plan by coordinating with clinical teams, payers, and discharge planners to support timely care progression and appropriate resource use. Implementation:
Implements review processes to evaluate necessity and efficiency of services. Initiates communication with physicians and payers to resolve authorization issues and prevent delays in care. Evaluation:
Continuously evaluates the appropriateness of hospital admissions, continued stays, and treatment plans in accordance with payer guidelines and evidence-based practice. Quality of Practice:
Promotes quality through evidence-based utilization review processes and contributes to performance improvement initiatives. Education:
Maintains current knowledge in UR/UM practices, payer requirements, clinical guidelines, and regulations affecting utilization management. Professional Practice:
Evaluates personal practice against professional standards, licensing requirements, and Hennepin Healthcare policies. Collegiality:
Collaborates with nursing, providers, case management, finance, and payer representatives; supports team education and professional development. Collaboration:
Uses relationship-based care to collaborate with care teams, patients, families, and external entities to facilitate effective care coordination and appropriate resource utilization. Ethics:
Applies ethical decision-making in authorization issues, appeals, and coverage decisions; advocates for patient needs while balancing organizational goals and payer requirements. Evidence-Based Nursing Practice and Nursing Research:
Applies evidence-based criteria for utilization review decisions and supports data collection and reporting to improve outcomes. Resource Utilization:
Considers safety, effectiveness, cost, and legal compliance when recommending levels of care or authorizations; ensures documentation supports accurate coding, billing, and compliance. Leadership:
Demonstrates leadership through decision-making, multidisciplinary communication, and proactive problem-solving related to authorization and utilization challenges. Self-Evaluation:
Reviews and reflects on own practice relative to guidelines, regulations, and departmental goals. Safe Practice:
Participates in maintaining a safe, efficient, and regulatory-compliant work environment; adheres to Hennepin Healthcare protocols and confidentiality standards. Provide Education and Mentorship:
Demonstrates knowledge of adult learning principles and promotes the HHS Nursing Vision and Practice Model. Qualifications
Minimum Qualifications:
1 year of recent
utilization review, utilization management or care coordination
nursing experience. Preferred Qualifications:
1 year of recent ED or Psych UR/UM nursing experience preferred; Bachelor’s degree in nursing; Certification in area of clinical specialty; minimum 2 years of clinical experience (e.g., med/surg, ICU, ED, or case management); strong understanding of UR/UM principles; familiarity with InterQual, MCG, or similar tools; excellent critical thinking, communication, and documentation skills; proficiency with EMRs and healthcare documentation systems; BSN preferred; advancement in academic education discussed during performance review. License/Certifications:
Possession of a valid Minnesota RN license; some positions may require specialized certifications. Additional Information
You’ve made the right choice in considering Hennepin Healthcare for your employment. We offer a wealth of opportunities to make an impact in patients’ lives and provide Equal Employment Opportunities to current and prospective employees. Offers of employment are conditional and contingent upon successful clearance of background checks and pre-employment requirements. Total Rewards Package: Competitive pay based on skills, licensure/certifications, education, experience, and internal equity. Comprehensive benefits including Medical, Dental, Vision, Life, Short and Long-term Disability, Retirement Funds, Paid Time Off, Tuition reimbursement, and license/certification reimbursement (Available only for benefit eligible positions). For a complete list of benefits, visit our career site. Department: Utilization Management
Primary Location: MN-Minneapolis-Downtown Campus
Standard Hours/FTE Status: FTE = 0.80 (64 hours per pay period)
Shift Detail: Day, Evening, Every Other Weekend
Employee Status: Regular
Eligible for Benefits: Yes
Union/Non Union: Union
Min / Max: $36.70 / $69.38
Job Posting: Oct-01-2025 #J-18808-Ljbffr