Utilization Management RN

St. Cloud Hospital is seeking a dynamic and experienced Utilization Management RN to join our team. In this pivotal role, the Utilization Management Nurse will play an integral part in determining the optimal level of care for each patient admission while ensuring adherence to regulatory guidelines and maximizing reimbursement. 

Key Responsibilities:

• Collaborate seamlessly with multidisciplinary teams, including Care Management staff, physicians/providers, physician advisors, and leadership, to assess and determine the most suitable level of care for hospital admissions.
• Facilitate efficient communication and coordination with billing department, claims analysts, insurance representatives, and Revenue Cycle department to ensure precise claims submission and reimbursement processes.
• Execute essential components of the St. Cloud Hospital Care Management and Utilization Management plans, encompassing activities such as monitoring utilization of acute care services, identifying, and reporting quality indicators, and engaging in payer certification procedures.
• Adhere rigorously to the Utilization Management Plan guidelines to uphold cost-effective care delivery and ensure compliance with Centers for Medicare and Medicaid Services Conditions of Participation (CoP) Utilization Review standards.
• Champion patient and family-centered care in alignment with The Nursing Compass: St. Cloud Hospital's Nursing Professional Practice Model, fostering an environment that reflects our mission of enhancing health and quality of life inspired by the healing mission of Jesus.
• Deliver tailored, age-appropriate care to patients and families, while prioritizing and implementing robust patient safety practices.

Position Details: 

• Days and evening shifts, 7am-3:30pm and 3pm-11:30pm. 
• Flexible start times between 7:00am -8:00am for day shifts.
• Rotating weekends, approximately 8 per year, holidays approximately 1 per year. 
• Orientation may require travel to St Cloud Hospital for on-site training. 
• Shifts vary week to week and some weeks may have one shift scheduled, with the following week having 4 shifts scheduled. 

 Benefits: 

• Open communication amongst the team and leaders.
• A work environment focused on growth where employees are supported to building their skills, leverage networks, and seek out improvement.
• We offer a generous benefits package that includes medical (choose between an HRA or HSA), dental, flexible spending accounts, PTO, 401(k) retirement plan & match, LTD and STD, tuition reimbursement, discounts at local and national businesses and so much more! 

Qualifications: 

• Bachelor's Degree or higher degree in nursing required. 
• Registered Nurse (RN) Current licensure as a registered nurse in the State of Minnesota required. 
• 2 years of relevant clinical experience or other related experience in any of the following functions: utilization review/management, case/care management, and/or discharge planning related experience is required.
• Acute care clinical experience required.
• Excellent interpersonal communication, conflict resolution, and negotiation skills are necessary.
• Strong analytical, data management, and PC skills.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, providers, payors, and patients and their families.
• A working knowledge of medical legal issues in health care with special emphasis on documentation issues preferred. 
• Current working knowledge of discharge planning, utilization management, case management, managed care preferred.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources preferred.

CentraCare has made a commitment to diversity in its workforce. All individuals including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.