RN Care Manager

at  Providence Swedish

DESCRIPTION

The Utilization Review RN provides assessment and analytical support to concurrent and retrospective quality and utilization activities, in accordance with the Providence Hospital Quality and Utilization Plans, Medicare regulations, The Joint Commission regulations, guidelines and direction received from Administration and the Medical Staff. Works as a catalyst to promote coordination of care, continuity of care in the achievement of consistent and/or expected clinical conditions and is a patient advocate in utilization of efficient resource management. Coordinates the care for complex patients from pre-admission to immediate post-discharge. Participates in facilitating coordination and communication between all members of the health care team, in the decision making process to minimize fragmentation of the care delivery system and prevent hospital readmissions. The Utilization Review RN assists the health system in assuring financial viability by performing comprehensive medical reviews utilizing appropriateness criteria and interpreting implication of clinical status / medical treatment plan with current federal regulations guidelines; thereby facilitating accurate and timely billing process and payment, consistent with regulatory requirements.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Centralia Hospital and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

REQUIRED QUALIFICATIONS:

• Associate’s Degree in Nursing.
• Upon hire: Washington Registered Nurse License.
• 3 years Medical-surgical (or comparable acute care) nursing experience.

PREFERRED QUALIFICATIONS:

• Bachelor’s Degree in Nursing or health-related field or equivalent educ/experience.
• 1 year Recent acute care experience.
• Quality and/or utilization review and/or case management experience.
• Microsoft Office (Word and Excel) experience.

Please refer the Job description for details