Utilization Review Nurse (0.9 FTE/Days)

Welcome to a medical center where you

're the center of attention.

Pay range:

-

Hourly$51.79 - $77.69

Utilization Review Nurses collaborate with the care team across the continuum to assure high quality, safe and cost effective patient care. Utilization Review Nurses drive adherence to regulatory and payer guidelines and work in partnership with Social Workers to assure appropriate continuity of care before, during and after hospitalization.

• Performs preadmission, admission and continued stay reviews to ensure appropriate patient class and medical necessity of all observation and acute care hospitalizations.

• Utilizes clinical knowledge and expertise to assure patients are receiving the right care at the right time.

• Intervenes with physicians, nursing, social work and ancillary departments to resolve delays in service, inappropriate patient class or quality of care issues.

• Follows up with attending physicians when patients do not meet MCG criteria and/or clinical criteria that supports acute care hospitalization/observation. Utilizes Physician Advisor when contact with the attending physician has not resulted in resolution.

• Acts as a consultant to educate patients, families and staff regarding Medicare/Medicaid guidelines, compliance with external review organizations and potential alternatives to acute care hospitalization.

• Maintain assigned work queues such as discharges, short stays, prior authorization, etc

• Reviews all observation cases to ensure appropriate setting, admissions, or timely discharge.

0.9 FTE - 36 hours per week

Qualifications:

• Associate’s degree in nursing required. Bachelors or Masters in nursing preferred.

• Current Washington State license as a Registered Nurse required. Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification preferred. For incumbents hired prior to December 1, 2014, an LPN license plus five years of additional experience is acceptable.

• Three years acute care experience required. Prior utilization management, case management, compliance, or payer experience required.

• Ability to effectively present information and respond to questions from groups of managers, patients, physicians, and payors.

• Knowledge of word processing, spreadsheet, database, and presentation software.

Why join Overlake?

We're proud to offer benefits that support you in every stage of your career and life. But it's our inspirational culture that has made us one of America's Top 150 places to work in healthcare for several years in a row.

• Local, visible leaders who care about you.
• A values-based work environment.
• Medical insurance premiums as low as $0 per month.
• Many Overlake services covered at 100%.
• Tuition reimbursement up to $10,000 per year.
• Generous retirement plan matching starting at 5% and increasing to 7% after five years with immediate vesting.
• Pre-tax and Roth after tax retirement savings plans.
• An expanded Employee Assistance Program.
• A caregiver support program to help with everything from childcare to eldercare.
• Free parking and Orca transit passes.

If this sounds like an environment where you'll thrive, we'd love to hear from you.