Utilization Review RN, Manager

Job ID 2021-38756
Area of Interest
Utilization Review
Location Name
818 Stewart
FTE/Hours per pay period
1.0 FTE (80 hours per bi-weekly pay periods)
Work Status
Regular
Department
Utilization Review
Shift
Day Shift
Primary Location : City
Seattle
Primary Location : State/Province
WA

About Us

Hospital About Us:

 

Hope. Care. Cure. These three simple words capture what we do at Seattle Children’s –- to help every child live the healthiest and most fulfilling life possible. Are you ready to engage with a mission-driven organization that is life-changing to many, and touches the hearts of all? #HOPECARECURE

 

Our founding promise to the community is as valid today as it was over a century ago: we will care for all children in our region, regardless of the families’ ability to pay. Together, we deliver superior patient care, advance new discoveries and treatments through pediatric research, and serve as the pediatric and adolescent, academic medical center for Washington, Alaska, Montana and Idaho – the largest region of any children’s hospital in the country.

 

In 2020, U.S. News & World Report once again ranked Seattle Children’s among the nation's best children's hospitals – for the 27th year in a row. We received national rankings in all 10 specialty areas evaluated by U.S. News & World Report, and are honored to be the only pediatric medical center in Washington to be ranked.

 

As a Magnet designated institution, and classified among America’s best large employers by Forbes, we recognize the importance of hiring and developing great talent to provide best-in-class care to the patients and families we serve. Our organizational DNA takes form in our core values: Compassion, Excellence, Integrity, Collaboration, Equity and Innovation. Whether it’s delivering frontline care to our patients in a kind and caring manner, practicing the highest standards of quality and safety, or being relentlessly curious as we work towards eradicating childhood diseases, these values are the fabric of our culture and community. The future starts here.

Overview

Provide leadership with a clinical perspective for daily operations of the Utilization Review Department to achieve the goals set by executive and Revenue Cycle leadership in a telecommuting/remote work setting. Develop and coach supervisors and front line teams to ensure processes are stable or continuously improving to achieve compliant, pre-claim payor authorization for reimbursement, with a high level of integrity and customer service. Collaborate across enterprise departments to identify patient admission funding gaps and resolve problematic accounts to achieve Revenue Cycle target outcomes which typically relate to maximum expected reimbursement for hospital admissions. Partner with clinical teams and the Inpatient Care Coordination team to escalate utilization issues like avoidable discharge delays. Leverage data and experience to assist with analysis and implementation of system level interventions to address inappropriate utilization of inpatient hospital resources and barriers to discharge. Functional assignments are fluid and may be reassigned or reprioritized to address business needs. Accept other duties as assigned by Sr. Leaders.

 

#LI-PM

Requirements

Required Education/Experience:
- Bachelor’s degree in Nursing. A Master’s degree in Nursing may be substituted provided the incumbent also possesses a Bachelor’s degree in another field.
- Minimum three years of inpatient acute care nursing experience, preferably in pediatrics.
- Minimum three years of relevant authorization, utilization review, case management, or denial management experience, either at a health plan or within a health care delivery system.
- Minimum tthree years in a supervisor or manager role supporting the functions of utilization review, either at a health plan or within a health care delivery system.
- Demonstrated competency with the use of MCG and Interqual criteria sets.
- Knowledge of health care funding with previous experience working with or for health insurance carriers, preferably in a utilization management role.


Required Credentials:
- Current Washington State RN licensure.
- Current Basic Life Support (BLS) for Healthcare Providers. Pediatric Emergency Assessment, Recognition and Stabilization (PEARS), and Pediatric Advanced Life Support (PALS) will be accepted in lieu of BLS for Healthcare Providers.

Preferred:
- 5 years experience with insurance authorization and/or utilization review processes.
- 5 years inpatient pediatric nursing experience.
- Knowledge of health care funding with previous experience working with or for health insurance carriers, preferably in a utilization management role.
- Case Management Certification.

Our Commitment to Diversity

Our community welcomes diverse experiences, backgrounds, and thoughts as this is what drives our spirit of inquiry and allows us to better connect with our increasingly diverse patients and families. Our organization recruits, employs, trains, compensates, and promotes without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

The people who work at Seattle Children's are members of a community that seeks to respect and celebrate all the qualities that make each of us unique. Each of us is empowered to be ourselves within this community, which cultivates and promotes equity, diversity, and inclusion at all levels.

Seattle Children's is proud to be an Equal Opportunity Workplace and Affirmative Action Employer.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed