Providence Health & Services Utilization Management Nurse in Seattle, Washington
Providence is calling a Utilization Management Nurse (Day Shift, 1.0 FTE) to Providence ElderPlace in Seattle, Washington. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all – especially those who are poor and vulnerable.
In this position you will:
Coordinate information with IDT to ensure that timely discharge planning occurs.
Determine and issue denials to hospitals and other providers for unapproved stays, ensure communications to SNFs for approval or denial of extension of covered days.
Concurrent reviews of SNF and hospital admissions; using clinical criteria to determine the appropriateness of admissions, level of care and continued stay in sub-acute setting, and documenting the findings based on appropriate standards.
Lead analysis of sub-acute admissions and provide feedback to IDT and UM Committee regarding criteria and implementation of best practices.
Liaison with SNFs and hospitals utilizing problem solving techniques and conflict resolution skills to provide knowledge of PACE program and Providence ElderPlace (PEP).
Required qualifications for this position include:
Graduate of accredited school with Bachelor’s Degree in Nursing (BSN) or related degree
Current Cardiopulmonary Resuscitation (CPR) certification
Current Washington State: RN/PT/OT
Current Washington State drivers license
Proof of auto insurance
Requires knowledge of Medicare skilled nursing criteria
Minimum seven years experience in: Rehab medicine, skilled nursing facility with sub-acute care, discharge planning, case/care management required
Preferred qualifications for this position include:
Certified Case Manager Preferred
Some familiarity with Medicare acute care criteria preferred
Health plan experience preferred
About the ministry you will serve.
Providence ElderPlace is conveniently located in Seattle, WA. The PACE (Program for All-Inclusive Care for the Elderly) keeps older adults as healthy as possible in the community by providing comprehensive health care and social services including: primary and specialty medical care, a day health program, social work services, rehabilitation, housing (if necessary) and much more. The Providence ElderPlace team of health care and social service professionals and our affiliates provide comprehensive integrated care to our participants.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 76,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 475 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Req ID: 148961