Swedish Shared Services is looking for a Utilization Management Nurse \(Per Diem, Variable\) to work for the Case Management Department at Swedish First Hill in Seattle, WA\.
The Utilization Management Nurse encompasses a broad knowledge of health care delivery that includes but is not limited to managed care regulations, contract terms/stipulations, utilization review and governmental agency regulations\.
In this position you will:
- Collaborate and consult with appropriate departments and physicians as needed to determine that medical necessity indicators are met
- Support the Utilization Management process by sending reviews, entering requests for utilization review, authorization of stay concurrent and post billing denials to support the Case Management workflow
- Work in accordance with applicable state and federal laws, as well as, with the unique requirements of reimbursement systems
- Study information to remain informed of reimbursement modalities, resources, as well as, clinical and legal issues that affect patients and providers of care
Required qualifications for this position include:
- Nursing Baccalaureate degree \(BSN\) from an accredited school of nursing
- Current Washington State Nursing license
- Three or more years of RN experience in a clinical setting
Preferred qualifications for this position include:
- ACM or CCM certification
- One or more years of case management experience
About Swedish Shared Services:
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area\. Our expanding network of facilities currently includes three hospital locations in Seattle, a hospital in Edmonds and the new Swedish Issaquah campus\. It also consists of Swedish Medical Group's network of primary care clinics, and affiliations with suburban hospitals and specialty clinics throughout Greater Seattle\.
Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services\.
We offer a full comprehensive range of benefits — see our website for details
Our Non\-Profit Mission: Improve the health and well\-being of each person we serve\.
Since 1910, Swedish has been a hallmark of excellence\. Swedish has grown to become the largest non\-profit health provider in the Greater Seattle area with 11,000 employees, more than 2,800 physicians and 1,700 volunteers\. Swedish is committed to being the best place to receive care, and also the best place to work\. We reward our employees with generous compensation and benefits, individualized orientation, education and a supportive work environment\. Swedish is proud to be an Equal Opportunity Employer\. Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law\.
Schedule: On Call
Job Category: Case Management
Req ID: 136659