Utilization Management Specialist Nurse

You Belong Here.

At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and flexible schedules. We are connected by our mission - partnering and healing for a healthy future - and dedicated to the health and well-being of the communities we serve.

FTE: 1.0, Shift: Day, Schedule: Every other weekend

Position Summary

The Utilization Management (UM) Specialist Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient’s hospital stay. The UM Specialist Nurse facilitates Utilization Review (UR) compliance, and optimal reimbursement through oversight of their assigned licensed facility’s UR process including: accurate admission and continued stay reviews based on CMS regulations, UM criteria, certification and/or authorization, and complete chart documentation.

The UM Specialist Nurse serves a resource for Utilization Management clinical and support staff. This position assists with providing guidance on troubleshooting with complex cases and also assists with daily assignments of UM clinical and support staff to ensure patients are patients receiving timely and accurate reviews. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management. Work situations require specialized knowledge, judgment and skill and this position requires organization and interpretation of information relating to a wide variety of policies, procedures and programs.

Requirements

• Bachelor's degree in Nursing, or obtained within five (5) years from the initial date of hire; RN with 15+ years of service may be considered in lieu of education agreement
• Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
• Current Registered Nurse license in Washington State or Multistate License endorsement (MLS)
• Five years of clinical experience required; utilization management and/or insurance industry experience preferred

Our Values

As a MultiCare employee, we'll rely on you to reflect our core values of Respect, Integrity, Stewardship, Excellence, Collaboration and Kindness. Our values serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.

Why MultiCare?

• Belonging: We work to create a true sense of belonging for all our employees
• Mission-driven: We are dedicated to our mission of partnering for healing and a healthy future and the patients and communities we serve
• Market leadership: Washington state's largest community-based, locally governed health system
• Employee-centric: Named Forbes “America’s Best Employers by State” for several years running
• Technology: "Most Wired" health care system 15 years in a row
• Leading research: MultiCare Institute for Research & Innovation, 40 years of ground-breaking, clinical and health services research in our communities
• Lifestyle: Live and work in the Pacific Northwest - offering breathtaking water, mountains and forest at every turn

Pay and Benefit Expectations

Associated benefit information can be viewed here.