Utilization Management RN - Care Continuity
Location
United States
Posted
12 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Management RN - Care Continuity
University Health
Role Description Utilization Management Nurse (PRN UM RN) Optimize Care. Improve Outcomes. Elevate the Patient Experience. Are you a skilled RN with a passion for driving quality care while maximizing resource efficiency? Join our dedicated Utilization Management team and help shape smarter, more effective care delivery across the healthcare continuum. As a UM Nurse, you’ll play a critical role in supporting interdisciplinary collaboration, resource stewardship, and positive patient outcomes. You'll serve as a clinical advisor, problem solver, and resource utilization expert for our care teams. - Partner with interdisciplinary teams to ensure effective and efficient use of healthcare resources. - Monitor patient care delivery to align with best practices, regulatory standards, and financial goals. - Serve as an internal consultant to clinical staff, providing guidance on utilization practices, clinical documentation, and discharge planning. - Leverage data and clinical judgment to support timely transitions of care and optimize care coordination. - Participate in quality and performance improvement initiatives focused on resource utilization and patient-centered care. Qualifications - BSN preferred (or graduate degree in Nursing if BSN not held) - Active RN license in the state of Missouri - 2 years of clinical experience in an acute hospital setting - Proficiency with Windows-based programs and electronic health records - Strong verbal, written, and interpersonal communication skills - Excellent critical thinking, problem-solving, and organizational skills - Ability to thrive in a fast-paced, team-oriented environment Requirements - Previous Utilization Management experience - Familiarity with managed care, TJC, CMS standards, and performance improvement - Knowledge of ICD/CPT/DRG coding systems - Behavioral Health experience - Experience analyzing data or working with utilization metrics - National certification in Utilization Management or Case Management (e.g., ACM, CCM, or CMAC) Benefits - Be a key contributor to clinical excellence and financial sustainability. - Gain exposure to cross-functional teams and system-wide strategy. - Work in an environment that values innovation, education, and compassionate care. - Advance your career in a role where your voice, knowledge, and initiative matter. - Help us deliver smarter care and better outcomes—apply today to join our Utilization Management team.
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