Experience Inc. Jobs

Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization Management RN is an integral part of the multidisciplinary team, and is highly efficient at communication to progress patients through the continuum of care based on their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and efficient processes for determining appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

This individual is responsible for concurrent and continued stay Utilization Management related reviews and functions and for ensuring that appropriate data is tracked, evaluated and reported. This individual leads and/or actively participates in process improvement initiatives, working with a variety of departments and multidisciplinary staff.

This role effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively with a positive attitude with the Care team to promote timely progression throughout a patient’s stay.

Requirements:

• EDUCATION / CERTIFICATION / LICENSURE

• Required:

• Currently licensed as a Registered Professional Nurse in New York State.

• Associates Degree

• Preferred:

• Bachelor’s Degree in Nursing preferred.

• EXPERIENCE

• Required:

• 3 – 5 years acute hospital experience

• Utilization Management experience.

• Preferred:

• Hospital Case Management experience.

Salary Range: $80,000+

*Based on verified education & experience