Utilization Management Nurses

The Utilization Management (UM) Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for the Tandigm members identified as having a need for inpatient or outpatient certification, preauthorization and or concurrent review

The UM Nurse uses advanced nursing knowledge, evidence-based best practice, critical thinking skills, and excellent oral and written communication skills to ensure appropriate utilization of resources and patient quality outcomes. To all of this, the UM Nurses brings a passion for the work, a belief in the role, and a commitment to the patients and physicians served.

Education

  • Bachelor’s degree or graduate from an accredited school of Nursing.
  • Current Pennsylvania RN license.

Experience

Minimum:

  • 3-5 years of nursing experience in an acute care setting, with 3+ years of case management, discharge planning, or homecare experience preferred;
  • 2 + years of prior experience with Utilization Management

Knowledge, Skills & Abilities

  • Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness.
  • Ability to problem solve complex, multifaceted and emotionally charged situations.
  • Ability to make sound, independent judgments and act professionally under pressure.
  • Ability to effectively communicate and collaborate with physicians and other providers, patients, families, and ancillary staff.
  • Requires superior interpersonal skills; especially important will be the ability to engage and motivate patients, physicians, and service providers telephonically.
  • Knowledge of current “best practice” standards of patient care.
  • Thorough understanding of, and compliance with, RN scope of practice in the Commonwealth of Pennsylvania.
  • Excellent communication skills; ability to represent the organization to internal and external stakeholders with skill and confidence.
  • Organized, detailed, and proactive; responds to requests in a timely and efficient manner.
  • Collaborative and resourceful; functions successfully in a team environment as well as independently.
  • Computer literate with proficiency in Microsoft Office suite of programs.
  • Ability to type 45 wpm.
  • Knowledge of medical terminology, CPT and ICD coding.
  • Knowledge of IPA/group internal processes and contractual agreements.
  • Working knowledge of HMO/managed care/health plans.
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