Minimum 2 years experience as an RN * Minimum of at least 2 years as care management and/or utilization management experience preferred. * Minimum of 2 years of Med Surgical experience required;
Minimum 2 years experience as an RN * Minimum of at least 2 years as care management and/or utilization management experience preferred. * Minimum of 2 years of Med Surgical experience required;
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Identifies and reports Quality and Risk Management concerns. DCH Standards: * Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance ...
Minimum 2 years experience as an RN * Minimum of at least 2 years as care management and/or utilization management experience preferred. * Minimum of 2 years of Med Surgical experience required;
Minimum 2 years experience as an RN * Minimum of at least 2 years as care management and/or utilization management experience preferred. * Minimum of 2 years of Med Surgical experience required;
Riverview Regional Medical Center - Gadsden, AL We are seeking an Utilization Review Technician II , sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator ...
Riverview Regional Medical Center - Gadsden, AL We are seeking an Utilization Review Technician II , sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator ...
... utilization review. Review admissions and service requests within assigned unit for prospective ... Provide case management and/or consultation for complex cases. Assist departmental staff with ...
... utilization review. Review admissions and service requests within assigned unit for prospective ... Provide case management and/or consultation for complex cases. Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
... Utilization Review and Discharge Planning. Including but not limited to daily review of medical ... Minimum of three years nursing experience required. Three years' experience in case management or ...
... Utilization Review and Discharge Planning. Including but not limited to daily review of medical ... Minimum of three years nursing experience required. Three years' experience in case management or ...
... and manage multiple priorities, and to adapt to a rapidly changing environment. Key ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... and manage multiple priorities, and to adapt to a rapidly changing environment. Key ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... priorities and manage multiple priorities, and to adapt to a rapidly changing environment ... Assumes accountability for appropriate utilization of resources. * Performs other duties as ...
... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ... patients to appropriate levels of care, • Conduct patient assessments to determine readmission ...
... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ... patients to appropriate levels of care, • Conduct patient assessments to determine readmission ...
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
New
Alabama Registered Nurse License Experience: Three years experience in case management or utilization management preferred. Registered Nurse with at least one year clinical experience on a medical ...
New
Apprentice Utilization Management Nurse information
What is an apprentice utilization management nurse?
An Apprentice Utilization Management Nurse is a nursing professional in training who assists with the review and evaluation of healthcare services to ensure they are medically necessary and cost-effective. They work under the supervision of experienced utilization management nurses and follow established guidelines to assess patient care plans, medical records, and insurance policies. Their role is crucial in helping healthcare organizations maintain quality care while managing costs, and they may interact with physicians, patients, and insurance companies to clarify or justify treatment decisions. As apprentices, they are gaining hands-on experience to develop their skills and knowledge in utilization management.
What are the key skills and qualifications needed to thrive as an apprentice utilization management nurse, and why are they important?
To thrive as an Apprentice Utilization Management Nurse, you need a foundational understanding of nursing principles, strong analytical skills, and typically an RN license or progression toward one. Familiarity with utilization management software, electronic health records (EHR), and knowledge of insurance guidelines such as Medicare or Medicaid are often required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and conveying clinical information. These competencies ensure accurate patient care reviews, compliance with regulations, and effective support in healthcare cost management.
What are some common challenges faced by apprentice utilization management nurses, and how can they be addressed?
Apprentice Utilization Management Nurses often encounter challenges such as learning to interpret complex medical records, understanding insurance policies, and adhering to strict regulatory guidelines. Balancing patient advocacy with cost-effective care decisions can also be demanding. These challenges can be addressed by actively participating in mentorship programs, seeking regular feedback from experienced colleagues, and utilizing ongoing training resources provided by employers. Developing strong communication and organizational skills will also help manage the workload and foster effective collaboration with physicians, case managers, and insurance representatives.
What is the difference between Apprentice Utilization Management Nurse vs Utilization Management Nurse?
| Aspect | Apprentice Utilization Management Nurse | Utilization Management Nurse |
|---|---|---|
| Credentials | Licensed RN, in training or early certification stage | Licensed RN with certification in utilization review |
| Work Environment | Supervised training setting, often in healthcare or insurance companies | Independent review in healthcare or insurance organizations |
| Job Responsibilities | Assisting with case reviews, learning utilization review processes | Conducting case assessments, making coverage decisions |
The Apprentice Utilization Management Nurse is in training, focusing on learning review procedures under supervision, while the Utilization Management Nurse is fully qualified, responsible for independent case evaluations and decision-making. The apprentice role is a stepping stone toward becoming a licensed Utilization Management Nurse.
What are the most commonly searched types of Utilization Management Nurse jobs in Alabama?
The most popular types of Utilization Management Nurse jobs in Alabama are:
Full-time
Re-posted yesterday
DCH Health System rating
7.0
Based on 19 frontline employees who took The Breakroom Quiz
Job description
Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information and InterQual guidelines. The Utilization Review Nurse utilizes clinical knowledge to support the coordination and documentation and communication of medical services and/or benefits. The Utilization Nurse also serves on the liaison between the physicians, patients, payers and care managers regarding termination of benefits, denial notification, and expedited appeals. Has access to highly sensitive, confidential information.
- Evaluates medical records for appropriateness of admission status utilizing a combination of clinical information, screening criteria, and third party information. Collaborates with business office, care managers, attending physicians, and physician advisors as needed
- Conducts self-auditing of medical records for status accuracy and provides peer consultation regarding cases in which patients are failing to progress and/or experiencing significant deviation from the plan of care.
- Educates staff and physicians about managed care principles, observation status, discharge planning, and reimbursement rules.
- Works with Patient Registration\Financial Counselor (s) to identify correct insurance source and proper billing.
- Verifies patient admission information for each assigned patient within 24 hours of patient’s admission (next business day)
- Collaborates with the Case Manager to identify referrals to Financial Counselors.
- Negotiates resolution disagreements over the need for acute hospital level of care with the insurer.
- Collaborates with social workers for patients with complex, clinical, financial and psycho-social needs.
- Reviews physician orders and patient progression and intervenes with care coordination as needed. Collaborates with other departments to eliminate barriers, as necessary.
- Builds trusting relationships with attending physician, patient and/or family and other members of the healthcare team. Establishes a caring relationship with patients and their caregivers, promotes patient engagement and guides patients/families through the transition phase
- In accordance with established clinical guidelines/standards of care establishes a comprehensive care transition plan and will organize, secure, integrate and modify resources necessary to meet the goals stated in the assessment plan.
- Identifies Potential Avoidable Days per department policy.
- Gathers information for statistical monitors, plus special projects within the Care Management Department.
- Maintains records in a complete, detailed, and orderly manner.
- Updates and documents in Midas, pertinent clinical information by utilizing screening criteria and assigns next review date.
- Responsible to support and participate in department strategies and efforts focused on improving length of stay (LOS) and reduction of avoidable readmissions.
- Responsible to support and participate in department strategies and efforts focused on improving clinical documentation by physicians.
- Is knowledgeable of hospital mission, vision, and values and performs in a manner to support them.
- Identifies and reports Quality and Risk Management concerns.
DCH Standards:
- Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
- Performs compliance requirements as outlined in the Employee Handbook.
- Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
- Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
- Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
- Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
- Requires use of electronic mail, time and attendance software, learning management software and intranet.
- Must adhere to all DCH Health System policies and procedures.
- All other duties as assigned.
- Anyone hired after July, 2011 must meet the following:
- Minimum of Registered Nurse with current Alabama license.
- Minimum 2 years experience as an RN
- Minimum of at least 2 years as care management and/or utilization management experience preferred.
- Minimum of 2 years of Med Surgical experience required; Utilization Review experience preferred.
- Expected to work under minimal management supervision
- Efficient use of basic computer skills
- Ability to multi task, prioritize and effectively adapt to a fast paced changing environment
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the phone and typing on the computer.
- Work requires the ability to perform close inspection of computer generated documents as well as a PC monitor.
- Typical office working environment with productivity and quality expectations.
- Ability to establish priorities, meets deadlines, and maintains proper productivity.
- Ability to form positive, collaborative relationships with hospital staff, patients, families and payers.
- Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
- Ability to effectively negotiate with internal and external providers of patient care services.
- Ability to develop leadership skills and to serve as a role model for clinical staff.
- Ability to lead and actively participate in multidisciplinary teams.
- Ability to work independently or within a team structure.
- Excellent interpersonal skills, communication style and organization.
- Must be able to read, write legibly, speak, and comprehend English.
Working Conditions:
WORK CONTEXT
- Ability to form positive, collaborative relationships with physicians, colleagues, hospital staff, patients, families, and external contacts.
- Ability to provide guidance and direction to subordinates, including performance standards and monitoring performance.
- Ability to encourage and build mutual trust, respect, and cooperation among team members.
- Ability to communicate with people outside the organization and represent the organization to the public, government, and other external sources.
- Ability to work independently or within a team structure.
- May be exposed to environmental cleaning chemicals
PHYSICAL FACTORS
- Requires Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
- Ability to tolerate prolonged periods of sitting or standing and/or walking.
- Ability to reach reasonable distances to handle equipment.
- Good manual and finger dexterity.
- Must be able to perform the duties with or without reasonable accommodation.
- Hearing and vision must be normal or corrected to within normal range.
- Physical presence onsite is essential.
What DCH Health System employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About DCH Health System
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Tuscaloosa, AL, US
Year founded
1923