Role overview

Qualifications

Bachelor’s degree in Nursing, or obtained within three years from the initial date of hire
Five years of clinical experience required; utilization management and/or insurance industry experience preferred
Currently licensed as a nurse (State of Washington)
Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred

Responsibilities

Responsible for concurrent utilization management activities for a defined MHS Licensed Facility
Facilitates Utilization Review (UR) compliance and optimal reimbursement through oversight of the UR process
Serves as a resource for Utilization Management clinical and support staff
Participates in a collaborative team approach and works independently and cooperatively with health care staff and management

Key facts

Remote from: United States
Full time
98 - 175K yearly
English

Hard skills

Utilization Management Nursing Chart Abstraction Reimbursement Regulations Insurance Sales Nursing Administration Organizational Structure Language Interpretation

Other skills

Collaboration

About the company

MultiCare Health System

Health Care

MultiCare’s roots in the Pacific Northwest go back to 1882, with the founding of Tacoma’s first hospital. Over the years, we’ve grown from a Tacoma-centric, hospital-based organization into the largest, community-based, locally governed health system in the state of Washington. Today, our comprehensive system of health includes more than 300 primary, urgent, pediatric and specialty care locations across Washington, Idaho and Oregon, as well as 13 hospitals. We welcome patients from the entire Pacific Northwest region and our 20,000-plus team members — including employees, providers and volunteers — proudly care for the communities we serve. Without a doubt, our organization has changed over the years. But what has never changed, throughout our long history, has been our dedication to health and wellness of the people of the Pacific Northwest. Guided by our mission, vision and values, we are on continuous journey to deliver the services that our communities need, and to ensure access to those services, now and in the future.

Company details

Company typeLarge

IndustryHealth Care

Company size10001

Links

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Job description

Join a team that shares your calling

At MultiCare, you’re more than just a job title — you’re part of a team built on trust that cares for each other, our patients and our communities. Belonging here means living our mission and values every day. If your purpose and passions align with ours, you’ll find a place to grow, do meaningful work and build a career you love in a community that feels like home.

FTE: 1.0, Shift: Days, Schedule: M-F, variable hours.

Position Summary

The Utilization Management (UM) Principal Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed facility Principal UM Nurse is a link between the patient, health care team, organization leadership, and payers during the patient’s hospital stay. The Principal 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 Principal 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 three years from the initial date of hire
Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred
Currently licensed as a nurse (State of Washington)
Five years of clinical experience required; utilization management and/or insurance industry experience preferred

Why MultiCare?

Rooted in the local community

Partnering with patients, families and neighbors across the Pacific Northwest for more than 140 years.

Growth and education

Competitive tuition assistance, award-winning residencies, fellowships and career development to invest in you.

Well-being and support

Generous PTO, Code Lavender and Employee Assistance Programs to help you maintain balance and feel cared in your work and life.

Living our values

Respect, integrity, kindness and collaboration guide how we care for patients, communities and each other.

Belonging for all

Resource Groups and outreach programs help ensure every team member feels safe, seen, heard and valued.

Pacific Northwest lifestyle

Work and live where natural beauty, adventure and strong community connections are part of everyday life.

Pay and Benefit Expectations

We provide a comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off. As required by various pay transparency laws, we share a competitive range of compensation for candidates hired into each position. The pay scale is $98,336.16 - $174,826.08 USD. However, pay is influenced by factors specific to applicants, including but not limited to: skill set, level of experience, and certification(s) and/or education. If this position is associated with a union contract, pay will be reflective of the appropriate step on the pay scale to which the applicant’s years of experience align.

Associated benefit information can be viewed here.