HCA, Hospital Corporation of America Registered Nurse (RN) Case Manager, Utilization Review in Bountiful, Utah
MountainStar Healthcare is looking for an RN Utilization Review Case Manager. MountainStar is a Utah-based division of HCA, the nation’s leading provider of healthcare services. MountainStar has good reason to celebrate, and we are excited to invite a qualified candidate to join the MountainStar Team. This position will play a key role in continuing our success!
The Utilization Review Case Manager works in an office based in Bountiful, Utah, and from this location has the ability to provide support and services to 8 Utah hospitals, 2 hospitals in Idaho, and 1 in Alaska. The Utilization Review Nurse reviews the electronic medical records of patients in one or more of these hospitals and applies pre-determined criteria from InterQual®--a set of measurable, clinical indicators, as well as diagnostic and therapeutic services reflecting the need for hospitalization. The nurse will collaborate with insurance companies and hospital entities. The nurse will document all information related to insurance reimbursements in the appropriate computer systems—EPIC or MEDITECH.
- Performs admission review and continued stay review to determine the clinical appropriateness and medical necessity of the level of care ordered by the physician by applying InterQual® criteria.
- Initiates timely admission and continued stay reviews per Department Standards.
- Maintains current knowledge of Utilization Review standards and practices.
- Works well autonomously and as a team member.
- Excellent communication skills (oral and written) and customer service oriented.
- Demonstrates analytical and critical thinking abilities with pro-active decision making and negotiation skills.
- Provides clear and accurate information to insurance representatives, hospital facilities, and case managers.
- Promotes and maintains collaborative working relationships.
- Maintains professional intradepartmental and community relationships.
WWork Schedule: Full-time Days, Monday-Friday
- Utah State RN license or Interstate Compact License accepted
- Graduate of an accredited nursing program, diploma, associate degree or baccalaureate program
- 1-3 years of nursing experience in an acute care / hospital setting.
Working / Environmental Conditions
This is a sedentary position in an office setting. This position involves sitting most of the time. The position does not involve direct patient care.
Title: Registered Nurse (RN) Case Manager, Utilization Review
Location: Utah-Bountiful-Lakeview Hospital
Requisition ID: 06032-33307