Providence is calling a Registered Nurse Care Coordinator/Utilization Management to the Utilization Management & Clinicial Documentation Department at Providence Health & Services in Everett.
We are seeking a Care Coordinator Utilization Management to oversee utilization management and review of patients care delivery while in the hospital, as well as provide clinical reviews and denial appeals where appropriate either during admission or post discharge.
This is a .8 FTE (32 hours per week), night shift position. Working every other weekend is required.
In this position you will:
Review the electronic medical records to perform admission screens on new admits utilizing Interqual criteria to determine medical appropriateness of the hospital admission and to address appropriate patient class determination.
Perform continued stay reviews on current patients and communicate clinical information to payers in a timely manner such that the patient's hospital days are authorized.
Manage concurrent denials and facilitate peer to peer physician reviews.
Demonstrate age specific patient care considerations for the population served.
Coordinate with discharge planning through active organization and monitoring of the patient care process to provide continuity of care cost effectiveness.
Required qualifications for this position include:
Bachelor's Degree in Nursing (BSN).
Current RN license in Washington State.
Experience as an RN in an acute care (hospital) setting within the last five (5) years or recent utilization management experience.
Preferred qualifications for this position include:
Utilization review or case management experience.
Experience with Interqual or Milliman Criteria.
Utilization Management certification.
Case Management certification.
Care management, medical insurance or discharge planning experience.
For more information, please contact Colleen Deal, PHR, Senior Recruiter, at email@example.com .
About the hospital you will serve.
Providence Regional Medical Center Everett in Everett, WA is the state's most award-winning hospital for medical care; having received the HealthGrades Distinguished Hospital Award for Clinical Excellence four years in a row. Our new state-of-the-art 12 story hospital tower and the implementation of an electronic medical records system will significantly enhance our patient's experience throughout the continuum of care.
The hospital is located in Snohomish County on the Sound and close to the mountains, so outdoor activities such as snow skiing, kayaking, and golfing are at your doorstep. The communities in Snohomish have all the comforts and appeal of small towns, with historical districts, beautiful homes, interesting boutiques, and unique restaurants, yet the city life of Seattle and Bellevue are just 30 minutes south, while the cosmopolitan city of Vancouver, BC lies only 2 hours north.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.