- Bachelor's degree in Nursing, or obtained within three years from the initial date of hire
- Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
- Currently licensed as a nurse (State of Washington)
- Five years of clinical experience required; utilization management and/or insurance industry experience preferred
- Belonging: We work to create a true sense of belonging for all our caregivers
- Mission-driven: We are dedicated to our mission of partnering for healing and a healthy future and the patients and communities we serve
- Market leadership: Washington state's largest community-based, locally governed health system
- Employee-centric: Named Forbes "America's Best Employers by State" in 2023
- Technology: "Most Wired" health care system 15 years in a row
- Leading research: MultiCare Institute for Research & Innovation, 40 years of ground-breaking, clinical and health services research in our communities
- Lifestyle: Live and work in the Pacific Northwest - offering breathtaking water, mountains and forest at every turn
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Utilization Management Specialist RN - Remote, OR, United States - MultiCare Health System
Description
You Belong Here.At MultiCare, we strive to offer a true sense of belonging for all our employees.
Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and flexible schedules.
We are connected by our mission - partnering and healing for a healthy future - and dedicated to the health and well-being of the communities we serve.
FTE:
1.0, Shift:
Day, Schedule: Variable
Position Summary
The Utilization Management (UM)
Principal Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility.
The licensed facility Principal UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient's hospital stay.
The Principal 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 Principal 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
As a MultiCare employee, we'll rely on you to reflect our core values of Respect, Integrity, Stewardship, Excellence, Collaboration and Kindness.
Our values serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.
Why MultiCare?We 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 $107, $179,067.00 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.
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