Utilization Management Nurse II

Utilization Management Nurse II

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed.

Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired.

Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required.

Physical Requirements: Ability to perform job functions while standing, sitting, walking, climbing stairs, working indoors, working from elevated areas, working in confined/cramped spaces, performing job functions from kneeling positions, bending at the waist, twisting at the waist, squatting and performing job functions, performing 'pinching' operations, and fully using both hands/arms. Ability to fully use both legs, to reach in all directions, possess good finger dexterity, maintain tactile sensory functions, and maintain good olfactory sensory function. Ability to lift and carry up to 50 lbs, unassisted and lift/carry patients up to 350 lbs (+/-), assisted. Ability to lift objects from floor level to height of 36 inches, up to 50 lbs, unassisted. Ability to lower objects, to 50 lbs, from height of 36 inches, unassisted. Ability to push/pull objects up to 350 lbs (+/-), unassisted. Maintain 20/40 vision, corrected. See and recognize objects close at hand and objects at a distance. Ability to match or discriminate between colors, to determine distance/relationship between objects; depth perception and good peripheral vision capabilities. Ability to maintain hearing acuity, with correction, ability to hear and understand whispered conversations at a distance of three feet, must be ambidextrous. Ability to perform gross motor functions with frequent fine motor movements. Ability to be qualified physically (by medical personnel) for respirator use, initially and annually. Ability to deal effectively with stressful situations. Computer literacy, ability to work rotating shifts, provide extended leadership coverage as needed, ability to learn and use new processes, tools equipment as required.