St. Tammany Health System
Healthcare
RNUtilizationManager(PRN)
Neural analysis suggests this role is
optimal for Mid+ candidates.
“RN Utilization Manager (PRN) at St. Tammany Health System. Skills: Utilization review, Case management, Patient advocacy. Review patient charts for medical necessity. Coordinate patient care transitions”
What You'll Achieve.
Ensure appropriate level of care; Facilitate timely discharge planning; Optimize resource utilization
Industry & Context.
Problem resolution
What They're Looking For.
Must Have
RN license required, Associate's degree required, 2 years of experience in utilization review
Nice to Have
BSN preferred, Case management certification preferred
What You'll Do.
Review patient charts for medical necessity
Coordinate patient care transitions
Collaborate with physicians and healthcare teams
Ensure compliance with payer requirements
Document all utilization review activities
Identify opportunities for process improvement
How You'll Work.
Team & Collaboration
Physicians; Healthcare teams; Payer representatives
Communication Scope
Patient communication; Physician communication
Full Job Description
At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system. We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste. **JOB DESCRIPTION AND POSITION REQUIREMENTS** Scheduled Weekly Hours: TBD **Work Shift:** 0800-1700 (flexible) **Summary of the Job:** The Utilization Manager is responsible to assist in the development, planning, coordination, and administration of the activities of Utilization Management. Job responsibilities include but are not limited to the following: daily review of medical records to determine appropriateness and medical necessity of admission, continued stay, use of resources, and discharge readiness. Assumes responsibilities delegated by the Department Head. **Minimum Qualifications:** Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing. Five years of hospital nursing experience preferred. Experience in the field of Utilization Management activities highly preferred. Basic understanding of CPT-ICD-9 coding principles and DRG management preferred. Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing. Ability to demonstrate effective written and verbal communication skills and possess emotional and professional maturity. Highly organized and efficient in establishing priorities and performing tasks within specific timeframes. Self-motivator requiring minimal supervision. Views problems as a challenge and investigates alternatives which demand creativity, flexibility and the ability to work under stress. Responsible for maintain
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