Utilization Review Nurse - Toledo Hospital - Utilization Management
Location: Remote - OhioDepartment: Utilization ManagementWeekly Hours: 20Status: Part timeShift: Variable (United States of America)Pay Grade: $32.25 - $47.00This is a remote position; however, employment is limited to residents of certain U.S. states due to legal, tax, and regulatory requirements. At this time, we cannot offer employment to individuals residing in California, Colorado, Hawaii, Massachusetts, New Jersey, New York, Oregon, Pennsylvania, Washington, or U.S. territories. Eligibility is based an applicant’s primary residence at time of hire. Job Summary: As a Utilization Management RN, you look to maximize the quality and cost-efficiency of health care services at ProMedica. You will complete reviews for admissions and transfers and apply payer rules to obtain authorizations. You will work with physicians, nurses, and other members of the health care team to effectively allocate resources to ensure appropriate care. You will review cases and look for opportunities to improve hospital service utilization. The above summary is intended to describe the general nature and level of work performed by the positions. It should not be considered exhaustive. REQUIREMENTS Education: Graduate of approved NLN accredited School of Nursing Years of Experience: Minimum of 3 years acute care nursing experience License: Current RN licensed in the state of hire PREFERRED REQUIREMENTS Education: Bachelor’s degree Skills: Knowledge of insurance guidelines and federal, state, and local regulations. Experience with UR/UM in hospital acute care setting. Previous experience with case management, utilization review, and InterQual criteria ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health. For more information about ProMedica, please visit promedica.org/aboutus. Benefits: We offer a competitive benefits package with coverage effective day one of employment which includes dental, vision, company paid life insurance, paid time off, a 401k retirement plan, an employee assistance program and other voluntary coverage options and employee discounts. Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected] Equal Opportunity Employer/Drug-Free Workplace