REQ-0000126422 Job Description   UW Medical Center has an outstanding opportunity for an experienced Utilization Review Nurse to join our team. WORK SCHEDULE

• Fully remote / work from home
• Must be available to work day shifts during Pacific Standard Time
• Sat, Sun and one day during the week (8 hour shifts)

  POSITION HIGHLIGHTS

• Ensures the delivery of optimal care for our patients while promoting fiscal responsibility
• Maintains efficient, cost effective care management processes by determining the medical necessity and financial liability for all hospitalized patients
• Plays a key role ensuring compliance with regulatory requirements, policies, and procedures

  PRIMARY JOB RESPONSIBILITIES

• Identify clinical indications for admission
• Track hospital events and course in order to justify patient admission and continued stay for payer reimbursement
• Communicate with third party payers regarding patient clinical progress
• Assess and communicate potential reasons for payer denials and attempts to resolve the denial with the team at the time of identification
• Participate in activities of identifying high risk vulnerabilities to the organization
• Use critical thought processes and decision making in monitoring the continuum of care
• Support work at both UW Medical Center – Northwest and UW Medical Center - Montlake

  REQUIREMENTS

• 3 years of work experience in utilization management
• 5 years of nursing work experience in an acute care med-surg setting
• Bachelor's Degree in Nursing, or equivalent education and training
• Active licensure to practice as a Registered Nurse in Washington State by start date
• Knowledge of medical screening criteria
• Computer skills to appropriately navigate electronic charting and referral systems
• Case Management certification and previous experience with Xsolis software and MCG criteria preferred, but not required

  ABOUT UW MEDICINE – WHERE YOUR IMPACT GOES FURTHER UW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals.   All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest.   Become part of our team. Join our mission to make life healthier for everyone in our community.   Compensation, Benefits and Position Details   Pay Range Minimum: $108,000.00 annualPay Range Maximum: $150,000.00 annualOther Compensation: -Benefits: For information about benefits for this position, visit https://www.washington.edu/jobs/benefits-for-uw-staff/Shift: First Shift (United States of America)Temporary or Regular? This is a regular positionFTE (Full-Time Equivalent): 60.00%Union/Bargaining Unit: Not Applicable  About the UW    Working at the University of Washington provides a unique opportunity to change lives – on our campuses, in our state and around the world.   UW employees bring their boundless energy, creative problem-solving skills and dedication to building stronger minds and a healthier world. In return, they enjoy outstanding benefits, opportunities for professional growth and the chance to work in an environment known for its diversity, intellectual excitement, artistic pursuits and natural beauty.   Our Commitment    The University of Washington is committed to fostering an inclusive, respectful and welcoming community for all. As an equal opportunity employer, the University considers applicants for employment without regard to race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status consistent with UW Executive Order No. 81.   To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 or dso@uw.edu.   Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.