Job Description

Employment Type:

Shift:

Description:

Nazareth Hospital, a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management team!

Schedule:

Full-time, 40hrs/wk, Monday-Friday day shift.

Job Description:

Under the general supervision of the Manager of Utilization Management, the Utilization RN assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care by utilizing standard review criteria and organizational guidelines. Advocates to prevent avoidable delays and denials. Works collaboratively with the Denials Supervisor to identify denial trends and determine opportunities for documentation improvement.

This position is responsible for the coordinating and facilitating all aspects of reimbursement as related to the clinical review and level of care. Management of all review and appeals utilizing a modified approach based on specific needs of the patient population. Facilitates achievement of efficient resource consumption, and acceptable clinical outcomes, through integration and implementation of utilization management.

Minimum Qualifications:

• BSN or BA in Nursing

• PA RN License

• Two years of clinical experience, which includes utilization or case management experience in a hospital or managed care environment

• Case Management certification from an accredited organization preferred

We offer a competitive salary and comprehensive benefits including:

• Medical, Dental, & Vision Coverage (Effective first day of hire!)

• Relocation Assistance available

• Retirement Savings Program

• Paid Time Off

• Tuition Reimbursement

• Free Parking

• And more!

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.