ChristianaCare
Utilization Management (UM) Nurse - Day Shift
ChristianaCare, Newark, Delaware, United States, 19711
Utilization Management Nurse - Christiana Hospital
FT Day Shift (Hours: 8 AM - 4:30 PM) Hybrid
Newark, DE
This position is a hybrid role (not 100% remote). On-site presence is required, including attendance at multidisciplinary rounds and issuing patient insurance letters.
ChristianaCare Hospital in Newark, DE, is looking for a Utilization Management (UM) Registered Nurse with experience in an acute care hospital setting.
Responsibilities: The Utilization Management Nurse will be responsible for ensuring the efficient and effective delivery of healthcare services. This includes evaluating the medical necessity and appropriateness of utilizing healthcare services, procedures, and facilities in accordance with the relevant health benefits plan.
Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
Reviews the admission assessment and collaborates with the primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
Manages observation level of care and works with the attending physician and/or clinical provider caring for the patient to ensure observation status does not exceed 48 hours.
Identifies system issues that serve as barriers to care.
Participates in the development and implementation of strategies to remove barriers and facilitate performance improvement measures.
Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate the achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
Reports information generated from the utilization management referral process for LOS data and the physician profile database.
Collaborates with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
Notifies the physician when a patient does not meet criteria for acute care hospitalization and pursues documentation to justify continued stay within 24 hours.
Provides On-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to ChristianaCare.
Identifies the need for the patient to be evaluated by other members of the health care team and takes appropriate action to facilitate.
ED UM works closely with ED providers to review medical necessity and/or collaborate with ED CM for discharge planning, as appropriate.
Education & Experience Requirements: DE RN licensure or compact state licensure.
Bachelor’s degree in nursing (BSN) required.
At least 8 continuing education credits (CEUs) per year in Utilization Management is required.
Experience in Utilization Management preferred.
Minimum of 3 years of recent experience as a Registered Nurse in an acute care hospital setting, with experience in Critical care.
Actively participates in department operational planning work groups required.
Annual Compensation Range $85,862.40 - $137,384.00
This pay rate/range represents ChristianaCare’s good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
This position is a hybrid role (not 100% remote). On-site presence is required, including attendance at multidisciplinary rounds and issuing patient insurance letters.
ChristianaCare Hospital in Newark, DE, is looking for a Utilization Management (UM) Registered Nurse with experience in an acute care hospital setting.
Responsibilities: The Utilization Management Nurse will be responsible for ensuring the efficient and effective delivery of healthcare services. This includes evaluating the medical necessity and appropriateness of utilizing healthcare services, procedures, and facilities in accordance with the relevant health benefits plan.
Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
Reviews the admission assessment and collaborates with the primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
Manages observation level of care and works with the attending physician and/or clinical provider caring for the patient to ensure observation status does not exceed 48 hours.
Identifies system issues that serve as barriers to care.
Participates in the development and implementation of strategies to remove barriers and facilitate performance improvement measures.
Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate the achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
Reports information generated from the utilization management referral process for LOS data and the physician profile database.
Collaborates with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
Notifies the physician when a patient does not meet criteria for acute care hospitalization and pursues documentation to justify continued stay within 24 hours.
Provides On-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to ChristianaCare.
Identifies the need for the patient to be evaluated by other members of the health care team and takes appropriate action to facilitate.
ED UM works closely with ED providers to review medical necessity and/or collaborate with ED CM for discharge planning, as appropriate.
Education & Experience Requirements: DE RN licensure or compact state licensure.
Bachelor’s degree in nursing (BSN) required.
At least 8 continuing education credits (CEUs) per year in Utilization Management is required.
Experience in Utilization Management preferred.
Minimum of 3 years of recent experience as a Registered Nurse in an acute care hospital setting, with experience in Critical care.
Actively participates in department operational planning work groups required.
Annual Compensation Range $85,862.40 - $137,384.00
This pay rate/range represents ChristianaCare’s good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.