FTE: 1.0,
Shift: Days,
Schedule: M-F, variable hours.
Appeal or denial work experience is highly preferredPosition SummaryThe Utilization Management (UM) Specialist Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient's hospital stay. The UM Specialist Nurse facilitates Utilization Review (UR) compliance, and optimal reimbursement through oversight of their assigned licensed facility's UR process including: accurate admission and continued stay reviews based on CMS regulations, UM criteria, certification and/or authorization, and complete chart documentation.
The UM Specialist Nurse serves a resource for Utilization Management clinical and support staff. This position assists with providing guidance on troubleshooting with complex cases and also assists with daily assignments of UM clinical and support staff to ensure patients are patients receiving timely and accurate reviews. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management. Work situations require specialized knowledge, judgment and skill and this position requires organization and interpretation of information relating to a wide variety of policies, procedures and programs.
Requirements- Bachelor's degree in Nursing, or obtained within five (5) years from the initial date of hire; RN with 15+ years of service may be considered in lieu of education agreement
- Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
- Current Registered Nurse license in Washington State or Multistate License endorsement (MLS)
- Five years of clinical experience required; utilization management and/or insurance industry experience preferred
Pay and Benefit ExpectationsWe provide a comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off. As required by various pay transparency laws, we share a competitive range of compensation for candidates hired into each position. The pay scale is $98,336.16 - $174,826.08 USD. However, pay is influenced by factors specific to applicants, including but not limited to: skill set, level of experience, and certification(s) and/or education. If this position is associated with a union contract, pay will be reflective of the appropriate step on the pay scale to which the applicant's years of experience align.
Associated benefit information can be viewed here.
