Utilization Management Nurse

vor 1 Woche

Köln, Nordrhein-Westfalen, Deutschland Saint Francis Health System Vollzeit 50.000 € - 80.000 € pro Jahr

Current Saint Francis Employees - Please click HERE to login and apply.

Full TimeDays

#ALDIND

Shift: Monday-Friday with rotating weekends and eligible for hybrid remote 2 days per week after being in the role for 6 months.

Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of patients including, but not limited to their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to the improvement of internal processes.

Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Nursing.

Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License.

Work Experience: Minimum 2 years of related experience in an acute care setting.

Knowledge, Skills and Abilities: Ability to organize and prioritize work in an effective and efficient manner. Effective interpersonal, written, and oral communication skills. Demonstrated ability to integrate the analysis of data to discover facts or develop knowledge, concepts, or interpretations. Ability to be detail oriented as required in the examination of numerical data. Ability to synthesize clinical case data into concise summaries. Working knowledge of Microsoft Word, Excel and Access in the preparation of correspondence and reports.

Essential Functions and Responsibilities: Gathers, prepares and supplies required clinical/treatment information needed to obtain authorization within the review interval(s) time requirements. Participates in treatment team and/or Patient Care Committee by providing information about eligibility, benefits, and criteria for the selected level of care. Assists in discharge planning, as needed. Identifies QI Triggers for individual patient situations, reporting them promptly to the UM Manager, appropriate clinicians and Process Improvement/Quality Director. Reviews eligibility and benefits of patients to validate accurate level of care utilization. Investigates and prepares appeals for insurance companies when denial of reimbursement is related to medical necessity or to other treatment issues. Participates in quality-of-care and UM process improvement on an ongoing basis and assists with development of the UR Staff Committee's process improvement goals. Provides staff education to further the goals of UR.

Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.

Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Utilization Review Management - Yale Campus

Location:

Virtual Office, Oklahoma

EOE Protected Veterans/Disability

  • Werkstudentin im Management Team

    Vor 6 Tagen

    Köln, Nordrhein-Westfalen, Deutschland TÜV Rheinland Group Vollzeit 40.000 € - 60.000 € pro Jahr

    Industrial Services & CybersecurityAt TÜV Rheinland, in theIndustry Service & Cybersecuritybusiness unit, we are looking for talents who are ready to help shape the future of the industry and accompany technological progress. Our focus is on digitalization and networking in the industry, as well as the further international expansion of our services in the...

  • Project Manager

    Vor 5 Tagen

    Köln, Nordrhein-Westfalen, Deutschland N Consulting Global Vollzeit 60.000 € - 90.000 € pro Jahr

    Job Role: Project ManagerLocation: Cologne / Kunzalsau, GermanyContract RoleWork Mode : Hybrid (3 days from office)Language: GermanKey Responsibilities:Project Planning: Develop and maintain a detailed project plan outlining tasks, milestones, timelines, resource requirements, and dependencies for the project.Stakeholder Management: Establish and maintain...

  • Operations Manager

    vor 2 Wochen

    Köln, Nordrhein-Westfalen, Deutschland Tante-E GmbH Vollzeit 60.000 € - 80.000 € pro Jahr

    Deine AufgabenAls Operations Manager sorgst du dafür, dass unsere Agentur als Ganzes reibungslos funktioniert. Du stellst sicher, dass Prozesse, Ressourcen und Kommunikation zwischen den Teams optimal ineinandergreifen – damit Projekte effizient laufen, Kapazitäten richtig geplant sind und unsere Kund:innen bestmöglich betreut werden. Du arbeitest eng...

  • Warehouse employee

    Vor 7 Tagen

    Köln, Nordrhein-Westfalen, Deutschland ReCom Logistik Köln GmbH Vollzeit 30.000 € - 45.000 € pro Jahr

    Join the dynamic team at ReCom Logistik Köln GmbH, where we're redefining warehousing and storage solutions in the heart of Cologne. As a Warehouse Employee / Warehouse Clerk (m/f/d), you'll be an essential part of our operations, ensuring that everything runs smoothly and efficiently. Whether you're organizing shipments, managing inventory, or assisting...

  • Head of Sales

    Vor 7 Tagen

    Köln, Nordrhein-Westfalen, Deutschland Planet Pharma Vollzeit 80.000 € - 120.000 € pro Jahr

    A leading biopharmaceutical company is seeking aHead of Global Supply Chain Managementto lead the strategic orchestration of its end-to-end supply chain, with a strong emphasis onSales & Operations Planning (S&OP)andIntegrated Business Planning (IBP). Candidates must be based either in Germany (preferred) or Switzerland.The OpportunityReporting to senior...

  • Operations Manager

    vor 2 Wochen

    Köln, Nordrhein-Westfalen, Deutschland Tante-E GmbH Vollzeit 60.000 € - 80.000 € pro Jahr

    Wir sind eine der führenden Shopify-Agenturen in Deutschland und unterstützen Marken wie fritz-kola, LFDY, 3Bears, Union Berlin, kess Berlin, Develey, pinqponq, LeGer oder Brands aus "Die Höhle der Löwen" dabei, das Beste aus ihrem Online-Shop herauszuholen. Bei uns verschmelzen die Ideale von Tante-Emma-Laden und moderner E-Commerce Welt. Wir helfen dem...

  • Bauingenieurin Bauwerksprüfung

    vor 2 Wochen

    Köln, Nordrhein-Westfalen, Deutschland TÜV Rheinland Group Vollzeit 40.000 € - 80.000 € pro Jahr

    Industrial Services & CybersecurityAt TÜV Rheinland, in theIndustry Service & Cybersecuritybusiness unit, we are looking for talents who are ready to help shape the future of the industry and accompany technological progress. Our focus is on digitalization and networking in the industry, as well as the further international expansion of our services in the...

  • Event Operations Manager

    vor 2 Wochen

    Köln, Nordrhein-Westfalen, Deutschland Kings League Vollzeit 60.000 € - 90.000 € pro Jahr

    Kings League has become a global phenomenon that has revolutionized and elevated sport and entertainment to a new dimension. A new 7-a-side football league with teams chaired by the world's best streamers and content creators, with revolutionary rules aimed at uniting the best of football and e-sports.Passionate, optimist, open-minded and disruptive, we...

  • Full Stack Developer

    Vor 6 Tagen

    Köln, Nordrhein-Westfalen, Deutschland Erste Hausverwaltung Vollzeit 60.000 € - 90.000 € pro Jahr

    Willkommen bei der Erste Hausverwaltung GmbH, einem innovativen Unternehmen, das die Immobilienverwaltungsbranche technologiegestützt neu definiert. Seit 2021 setzen wir uns dafür ein, das Leben von Mieter:innen, Eigentümer:innen und Verwalter:innen durch einfache und sorgenfreie Lösungen zu bereichern. Mit rund 250 Mitarbeitenden in zwölf...

  • Senior Account Executive

    vor 1 Woche

    Köln, Nordrhein-Westfalen, Deutschland Everstream Analytics Vollzeit 90.000 € - 120.000 € pro Jahr

    See Further. Act Faster. Think Bigger.Everstream Analytics transforms risk intelligence with AI-driven insights to help businesses build agile, risk-optimized supply chains. By combining real-time data with advanced AI, our platform delivers early risk detection and actionable intelligence that integrates with planning, procurement, and logistics - enabling...