Swedish Health Services Utilization Management Nurse - Case Management in Seattle, Washington
Swedish Shared Services is looking for a Utilization Management Nurse (0.6 FTE / 24 hours per week, Evening Shift) to work for the Case Management Department at Swedish in Seattle, WA.
The Utilization Management Nurse encompasses a broad knowledge of health care delivery that includes but is not limited to managed care regulations, contract terms/stipulations, utilization review and governmental agency regulations.
Shift Schedule: 3:00pm- 11:30pm with alternating weekends
In this position you will:
Collaborate and consult with appropriate departments and physicians as needed to determine that medical necessity indicators are met
Support the Utilization Management process by sending reviews, entering requests for utilization review, authorization of stay concurrent and post billing denials to support the UM as well as the revenue cycle workflow
Work in accordance with applicable state and federal laws, as well as, with the unique requirements of reimbursement systems
Study information to remain informed of reimbursement modalities, resources, as well as, clinical and legal issues that affect patients and providers of care
Required qualifications for this position include:
Nursing Baccalaureate degree (BSN) from an accredited school of nursing
Current Washington State Nursing license
Three or more years of RN experience in a clinical setting
Preferred qualifications for this position include:
ACM or CCM certification
One or more years of case management / Utilization Management experience
Knowledge / proficiency in InterQual and or MCG
About Swedish Shared Services:
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area. Our expanding network of facilities currently includes three hospital locations in Seattle, a hospital in Edmonds and the new Swedish Issaquah campus. It also consists of Swedish Medical Group’s network of primary care clinics, and affiliations with suburban hospitals and specialty clinics throughout Greater Seattle.
Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services.
We offer a full comprehensive range of benefits — see our website for details
Our Mission is to improve the health and well-being of each person we serve.
Our Vision is Health for a Better World.
Swedish is the largest not-for-profit health care system in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty center in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, a network of more than 128 primary care and specialty care locations throughout the greater Puget Sound area. Swedish employs nearly 13,000 caregivers (all employees), including nearly 1,400 providers. Whether through physician clinics, education, research and innovation or other outreach, we're committed to caring for the people in our region and beyond. Swedish is proud to be an Equal Opportunity Employer Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Work Locations: Metropolitan Park East (WA152) 1730 Minor Avenue Metropolitan East Tower Seattle, 98101
Req ID: 274268