Employer Industry: Nonprofit Healthcare System

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits portfolio for full-time and part-time team members
- Chance to make a meaningful impact on patient care and community health
- Supportive and collaborative work environment with a focus on team dynamics
- Engage in a diverse range of healthcare services with a large nonprofit organization

What to Expect (Job Responsibilities):
- Review and monitor utilization of healthcare services to ensure cost-effective care
- Conduct medical necessity reviews for various payers upon admission and throughout the stay
- Facilitate the delivery of services by collaborating with care management teams and physicians
- Initiate and conduct follow-up chart reviews to maintain quality and continuity of care
- Identify admissions with specific diagnoses and notify appropriate staff of documentation issues

What is Required (Qualifications):
- Associate's Degree in Nursing from an accredited NLN/CCNE institution
- Minimum of 3 years of experience as a Registered Nurse in an acute care setting
- At least 1 year of experience in Utilization Review (UR), Utilization Management (UM), or Case Management
- Current Registered Nurse (RN) licensure in the state or compact state
- Strong understanding of medical necessity criteria and documentation compliance

How to Stand Out (Preferred Qualifications):
- Experience in a leadership role within a healthcare setting
- Familiarity with quality outcome measurements and healthcare regulations
- Advanced certification in Utilization Management or Case Management
- Proficiency in electronic medical records and documentation systems
- Strong analytical skills to assess care quality and efficiency

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