As an employee you will enjoy generous benefits and work/life programs. For detailed information on Benefits for this position, click here.
A higher degree of healthcare.
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.
UW Medical Center has an outstanding opportunity for a Utilization Management Nurse. The goal of the Utilization Management (UM) Nurse is to ensure delivery of optimal care for the patient while promoting fiscal responsibility.
The UM Nurse establishes and maintains an efficient, cost effective care management process by determining the medical necessity and financial liability for patients all hospitalized patients. The UM Nurse communicates this information with the interdisciplinary team to ensure compliance with regulatory requirements, policies and procedures, and quality patient care for the duration of the hospitalization. The UM Nurse is responsible for maintaining the knowledge and skill set related to utilization review, care coordination, and performance improvement, while working in a manner which supports the mission and vision of Care Management at University of Washington Medical Center. The UM Nurse ensures that daily operations, procedures and standards of care are maintained in accordance with hospital and JACHO guidelines.
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
Twenty hours per week with occasional weekend work requirements. Day shift.
Bachelor's Degree in Nursing or equivalent education and training
Five years nursing experience in an acute care med-surg setting.
A minimum of three years previous experience in utilization management required.
Knowledge of medical screening criteria required.
Able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on the assigned unit(s)/department.
Ability to handle a fluctuating workload
Computer skills consistent with electronic charting and referral system
Washington State RN license required by start date.
Case Management certification preferred.
Previous experience with MCG criteria preferred.
UW Medicine includes Harborview Medical Center, UW Medical Center
Montlake, UW Medical Center
Northwest, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest.
Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.
Committed to attracting and retaining a diverse staff, the University of Washington will honor your experiences, perspectives and unique identity. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming.
University Of Washington