Urgent! RN - Utilization Management - - Local Job Opening in Mount Pleasant
Job: RN - Utilization ManagementClassification: Hourly/Non-ExemptJob Category: 2 ProfessionalsPosition SummaryThe Utilization Management RN is responsible for evaluating medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities within the acute hospital setting.
This role supports timely and effective patient care while ensuring compliance with payer requirements, Medicare/Medicaid guidelines, and hospital policies.
The UM RN works closely with providers, nursing staff, case managers, and insurance representatives to promote appropriate resource utilization and high-quality care.Essential Functions-Knows and conforms to the Texas Nursing Practice Act, the Boards rules and regulations as well as Federal, State, or local laws, rules, or regulations affecting the RN's current area of nursing practice.-Conducts Clinical Reviews: Perform initial, concurrent, and retrospective reviews to determine medical necessity using evidence-based criteria (e.g., InterQual, MCG).-Reviews inpatient admissions, observation status, extended stays, and transfers.-Payer Communication: Submits clinical reviews to third-party payers.-Responds to insurance queries and participates in denial management and appeals.-Collaborates with Clinical Teams: Partner with physicians, nursing, case management, and social services to optimize patient care and length of stay.-Escalates cases to the physician advisor or medical director as needed.-Documentation & Reporting: Accurately documents UM activities and maintains records per hospital, CMS, and accrediting body standards.-Compliance & Education: Stays current with regulatory changes affecting UM practices.-Keeps director abreast of actions with patients, physicians/administrators, etc.-Able to work within EPIC and Indicia with adeptness and ease.
-Participates in the daily huddle and coordinates care of the patient with the whole team.
-Demonstrates an understanding of the operation of a health care computer system.-Performs general clerical duties as needed.-Demonstrates knowledge of utilization and financial issues of an acute health care facility.-Demonstrates effective oral and written communication skills.-Demonstrates supervision and leadership skills.-Adheres to and follows all patient experience initiatives.-Reports to and departs from work on time and as scheduled.-Performs other duties as assigned.-Must be able to deal with stress while maintaining composure.-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).Skills and Competencies:-Knowledge of InterQual, MCG, or similar utilization review criteria.-Understanding of Medicare/Medicaid, managed care, and commercial payer requirements.-Strong critical thinking, clinical judgment, and communication skills.-Proficient with EHR systems and UM software.-Ability to work independently in a resource-limited environmentWork Experience-Two years of Critical Care experience preferred.-Two years of Utilization Management experience preferred.Education-Registered Nurse currently licensed to practice in the State of Texas required.-CCM (Certified Case Manager) or ACM (Accredited Case Manager) preferred.-BLS (Basic Life Support) within 30 days of hire date required.Physical Demands and Work EnvironmentLifting/Carrying Pushing/PullingLbs.
% Time Lbs.
% Time1-10 34-66 1-10 34-6611-20 0-33 11-20 0-3321-50 0-33 21-50 0-3351-75 0-33 51-75 0-3376-100 None 76-100 NoneMovement % TimeBend/Stoop/Twist 0-33Crouch/Squat 0-33Kneel/Crawl 0-33Reach above Shoulder 0-33Reach below Shoulder 0-33Repetitive Arm 0-33Repetitive Hand 34-66Grasping 34-66Squeezing 34-66Climb Stairs 0-33Walking Uneven 0-33Walking Even 34-66Environment % TimeIndoors 67-100Outdoors 0-33Extreme Heat NoneDusty NoneExcessive Noise 34-66Equipment % TimeMotor Vehicles NoneFoot Pedals NoneExtreme Heat NoneDusty NoneExcessive Noise 0-33Work near % TimeMachinery NoneElectricity 0-33SHARPS 0-33Chemicals 0-33Fumes 0-33Heights NoneVisionDepth Perception Required< 20 RequiredColor Not RequiredPeripheral RequiredEndurance Hours at Once Total in 12HRSit 4 8Stand 1 2Walk 1 2ACKNOWLEDGEMENT: By electronically acknowledging this job description, I certify that I have been given the opportunity to review this job description.
I understand that this job description is intended to indicate the kinds of tasks and levels of difficulty that will be required of positions given this title.
It is not intended to limit or in any way modify the right of any supervisor to assign, direct and control the work of employees under supervision.
The use of a particular expression or illustration describing duties shall not be held to exclude other duties not mentionedthat are similar kind or level of difficulty.
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Unlock Your RN Utilization Potential: Insight & Career Growth Guide
Real-time RN Utilization Jobs Trends in Mount Pleasant, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for RN Utilization in Mount Pleasant, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 416962 jobs in United States and 1591 jobs in Mount Pleasant. This comprehensive analysis highlights market share and opportunities for professionals in RN Utilization roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! Titus Regional Medical Center is currently hiring and seeking a RN Utilization Management to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: RN Utilization Management Jobs Mount Pleasant.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at Titus Regional Medical Center adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a RN Utilization Management Jobs United States varies, but the pay scale is rated "Standard" in Mount Pleasant. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for RN Utilization Management typically include Healthcare Diagnosing Or Treating Practitioners and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your RN Utilization Management interview at Titus Regional Medical Center, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the Titus Regional Medical Center's products or services and be prepared to discuss how you can contribute to their success.
By following these tips, you can increase your chances of making a positive impression and landing the job!
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