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University of Washington UTILIZATION REVIEW NURSE, PART-TIME, WEEKENDS in Seattle, Washington

Req #: 236617

Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT

Job Location Detail: Position supports both UW Medical Center campuses

Posting Date: 07/10/2024

Closing Info: Open Until Filled

Salary: 50% or 60% of $8,500 - $12,500 per month

Shift: First Shift

Notes: As an employee you will enjoy generous benefits and work/life programs. For detailed information on Benefits for this position, click here. (https://hr.uw.edu/benefits/wp-content/uploads/sites/3/2018/02/benefits-professional-staff-librarians-academi-staff-20210208.pdf )

UW Medical Center has an outstanding opportunity for an experienced Utilization Review Nurse (UM RN) to join our team.

WORK SCHEDULE

  • Fully remote / work from home

  • Must be available to work day shifts during Pacific Standard Time

  • 50% position - 20 hours/weekend (two - 10 hour shifts)

  • 60% position - 24 hours/week (two - 8 hour shifts on the weekend plus one weekday shift) POSITION HIGHLIGHTS

  • Ensures the delivery of optimal care for our Behavioral Health and med/surg patients while promoting fiscal responsibility

  • Maintains efficient, cost effective care management processes by determining the medical necessity and financial liability for all hospitalized patients

  • Plays a key role ensuring compliance with regulatory requirements, policies, and procedures PRIMARY JOB RESPONSIBILITIES

  • Identify clinical indications for admission

  • Track hospital events and course in order to justify patient admission and continued stay for payer reimbursement

  • Communicate with third party payers regarding patient clinical progress

  • Assess and communicate potential reasons for payer denials and attempts to resolve the denial with the team at the time of identification

  • Participate in activities of identifying high risk vulnerabilities to the organization

  • Use critical thought processes and decision making in monitoring the continuum of care REQUIRED POSITION QUALIFICATIONS

  • 3 years of work experience in utilization management

  • 5 years of nursing work experience in an acute care med-surg setting

  • Bachelor's Degree in Nursing, or equivalent education and training

  • Active licensure to practice as a Registered Nurse in Washington State

  • Knowledge of medical screening criteria

  • Computer skills to appropriately navigate electronic charting and referral systems DESIRED

  • Case Management certification preferred

  • Previous experience with Xsolis software and MCG criteria preferred ABOUT UW MEDICINE – WHERE YOUR IMPACT GOES FURTHER UW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals.All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest. Become part of our team. (https://www.uwmedicine.org/jobs) Join our mission to make life healthier for everyone in our community.

University of Washington is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.

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