RN - Registered Nurse (Remote, Casual) - Utilization Management

About the position Seeking a Registered Nurse to serve Essentia Health on a casual, as-needed basis in our Utilization Management department. This job is fully remote. To qualify for this position, an RN must have a minimum of one year of acute care experience. There is no on call, but some weekends and holidays are required. Residents of Alaska, California, Hawaii, Massachusetts, New York, New Jersey, Washington and Oregon are ineligible to apply. About Essentia Health: We are a top-rated employer offering work-life balance, long term career stability, opportunities for growth, and work you can be passionate about! Our mission guides us every day: We are called to make a healthy difference in people’s lives. This calling resonates deeply for our caregivers and our colleagues working behind the scenes, who all bring high-quality, compassionate care to the patients we are privileged to serve. We are like nowhere else: https://vimeo.com/284233541 What You'll Do: Performs day-to-day activities involved in the utilization management process and assists in the promotion and maintenance of high quality and continuity of care in a cost-effective manner. This position requires high level of customer service skills to establish and enhance positive relationships with patients, co-workers, physicians and others. Collaborates with the related providers to ensure appropriate quality of care and utilization of designated patient services. Provides management of care delivery to patients and families of all ages. This includes assessing, planning, and coordination of services to meet an individual’s health needs in a cost-effective manner. Will also be responsible for discharge planning and reviewing the medical necessity and utilization of services that are required. Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.

Responsibilities

• performing utilization review functions and acting as liaison to third party payers
• performing documentation and review to support medically unnecessary day (MUD) database
• participating in collaborative practice teams
• collaborating with physicians, providers and payers to resolve issues and problems
• investigating information for appeals on denied cases as assigned
• serving as a resource to physicians and ancillary staff to help determine appropriate admission status
• Collaborates with the related providers to ensure appropriate quality of care and utilization of designated patient services.
• Provides management of care delivery to patients and families of all ages. This includes assessing, planning, and coordination of services to meet an individual’s health needs in a cost-effective manner.
• Will also be responsible for discharge planning and reviewing the medical necessity and utilization of services that are required.

Requirements

• Current licensure as a Registered Nurse.
• Minimum of one year work experience in an acute care setting is required.
• BSN or ADN degree from an accredited school or college of nursing.
• Residents of Alaska, California, Hawaii, Massachusetts, New York, New Jersey, Washington and Oregon are ineligible to apply.

Benefits

• Employees scheduled 24+ hours weekly enjoy these benefits:

Health Insurance and HSA or FSA accounts

• Dental and Vision insurances
• Supplemental insurances- critical illness, accident, & hospital indemnity
• Paid short-term disability, long-term disability, and basic life insurance
• Supplemental Life and Accidental Death & Dismemberment insurance
• Tuition Reimbursement
• PTO accrual and 7 paid holidays per year
• Paid parental leave after one year
• Adoption assistance after one year
• Bereavement & Jury Duty (all regularly scheduled employees)
• All employees, including casual, enjoy these benefits:

Take Charge (employee wellness program)

• Guidance Resources (free confidential counseling)
• Employee discount program
• 401(k) retirement account (traditional & Roth)
• 401(k) matching & discretionary contributions (subject to service requirements)
• At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health.

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