RN - Care Manager Utilization Review

Join a dynamic healthcare team in the Pacific Northwest as a Registered Nurse Care Manager specializing in Utilization Review. This role involves coordinating care and managing service utilization for patients in acute and post-acute skilled settings. You will collaborate closely with interdisciplinary teams both inside and outside the organization to enhance patient outcomes and ensure cost-effective care.

Job Summary

As a vital member of the care team, you will continuously evaluate the appropriateness and timeliness of care levels, ensuring resources are used efficiently. Your daily responsibilities include assessing ongoing needs for hospitalization and skilled care, conducting patient rounds and assessments, and facilitating smooth transitions from hospital to home or other care facilities.

Key Responsibilities

• Evaluate patient care needs and resource availability to assure appropriate utilization.
• Work collaboratively with interdisciplinary teams to develop and implement goal-oriented, age-appropriate care plans.
• Identify and resolve discharge barriers, ensuring patient and family understanding of insurance guidelines and referrals.
• Maintain thorough and timely documentation in accordance with department standards.
• Support concurrent denial processes through effective communication with nursing and provider peers.
• Adapt to changing work environments and lead others through transitions.
• Build and maintain trusting relationships with patients, families, and healthcare professionals.
• Engage in ongoing professional development and contribute to team activities and strategic planning.

Education and Experience

Skills and Abilities

Work Environment and Benefits

This full-time exempt position offers a supportive work environment with comprehensive benefits designed to promote wellness, professional growth, and financial security. Benefits include competitive compensation, medical and dental coverage, vision care, life insurance, disability plans, retirement contributions, employee assistance programs, tuition reimbursement, wellness initiatives, and access to on-site fitness facilities.

Regional Highlights

Located in a scenic area of the Pacific Northwest, the region offers abundant outdoor activities such as hiking through lush rainforests, kayaking on pristine waters, whale watching, fishing, and hunting. Nearby communities provide cultural attractions, educational opportunities, and a welcoming small-town atmosphere with easy access to metropolitan amenities.