RN Utilization Mgmt Full-Time Day

Job Description

The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management, and the UM process.

Coordinates care submission relating to the process of health care utilization from the point of patient admission to discharge. Assignments may also include management of the clinical denials process in collaboration with finance team. Processes will include arrangement and coordination of documentation for inpatient admissions with continued and extended hospital stays, and discharge review that determine medical necessity.

The RN UM will complete and coordinate MCG as needed related to Observation patients including contact with insurance for authorization as needed. The RN UM ensures high quality care and efficiency of utilization available through healthcare resources, facilities, and services substantiating health plan reimbursement categories. T

his role communicates with the interdisciplinary care team to support the UR process and care management criteria.

Qualifications

A. Education

• Associates Degree in Nursing required.
• BSN preferred.

B. Qualifications/Experience 

• Minimum 3-5 years recent experience in Case Management or Utilization Management or Prior Authorization
• Current California Registered Nurse License. Certification in UM or CM is highly preferredExperience in MCG and/or Interqual required
• A team player that can follow a system and protocol to achieve a common goalHighly organized and well developed oral and written communication skills
• Confidence to communicate and outreach to other community health care organizations and personnel Demonstrates sound judgment, decision making and problem solving skills

C. Special Skills/Knowledge

• Bilingual language skills preferred (Spanish)
• Basic computer skills
• Current Basic Life Support (BLS)
• CCM Certification preferred 

About the Hospital

MLK Community Healthcare (MLKCH) is a private, nonprofit, state-of-the-art, safety-net hospital with the mission of bringing the highest quality healthcare to the historically underserved communities of South Los Angeles. Since we opened our doors in 2015, we have made a meaningful impact on the lives and health of our neighbors. Come work with us.