Job Description
CENTSTONE SERVICES LLC is seeking RN Utilization Management for a travel / contract position in Piscataway, NJ. Accepting both local and traveler candidates.
Position Details:
Position Name: RN Utilization Management
Location: Piscataway, NJ
Specialty: UMStart Date: ASAP
Employment Type: Full-time, Travel, Contract, Temporary
Contract Length:13 weeks-Accepting Local and Travel Candidates
Pay Rate: Range $55-$60 pay (Non-taxable travel/housing and M&I stipend available for qualified/eligible travelers)
Unit: Long term care/ Rehab
Shift: 12 Hours; Nights, 8a – 5p
Schedule: 40 hours / week guaranteed, 5 shifts per week
Position Requirements:
- Registered Nurse: 2 years - Required
- UM experience: Recent/Current 2 years – Required
- Covid Vaccinations - Required
Education, License and Certification Requirements:
- ASN or an equivalent – Required
- BSN or an equivalent – Highly preferred
- RN License for State of NY - Required
- BLS Certifications from AHA - Required
- Chemo Certification - Preferred
Job Description:
- Review medical records. A utilization management nurse’s job description includes examining medical treatments and interventions to avoid payment denial and optimizing reimbursements by assessing the treatment’s appropriateness, effectiveness, timing, and setting. A prospective review occurs before treatment begins to eliminate unneeded, ineffective, or duplicate action. As treatment progresses, a concurrent review tracks resource utilization and patient progress to reduce denials. A retrospective study is then conducted to determine which treatments were successful and to ensure accurate reimbursement.
- Evaluate treatment plans. As a utilization management nurse, you’ll examine treatment plans with a critical eye. You must ensure the patient receives the best care while determining what level of treatment is necessary. You'll validate that the proposed plan aligns with established guidelines, protocols, and available resources. For instance, you may have to decide whether a patient should be admitted to the hospital, discharged to a lower level of care, or managed as an outpatient.
- Coordinate health care services. This role requires you to collaborate with other nurses, physicians, and health care providers while searching for essential information to confirm the patient’s insurer authorizes services. Many utilization management nurses work closely with case managers, or are case managers themselves.
- Manage resources. Health care costs continue to rise. Identifying areas to improve the cost-effectiveness of care while maintaining quality requires reviewing the utilization of health care resources, such as the length of hospital stay, medications, therapies, and diagnostic tests.
- Work with insurance and reimbursement. The utilization management nurse works with insurance companies to provide preauthorization information. That process helps ensure that appropriate reimbursement is received, and that the organization or patient isn’t stuck with unnecessary payments. Utilization management nurses may also get involved with investigating and appealing insurance denials.
- Compliance and documentation. All nurses know the importance of documentation, but it’s especially essential in nurse utilization management. Inadequate patient records can create roadblocks to care coverage. Utilization management nurses ensure that services comply with regulatory and accreditation standards. Clear documentation is also essential to maintain accurate, detailed documentation of utilization management activities and outcomes.
Job Types: Full-time, Contract, Travel nursing
Pay: Up to $55.00 per hour
Expected hours: 40 per week
Healthcare setting:
Medical specialties:
Schedule:
- 5x8
- 8 hour shift
- Day shift
- Monday to Friday
- Night shift
Experience:
- Nursing: 1 year (Preferred)
License/Certification:
- BLS Certification (Preferred)
- RN (Preferred)
Ability to Relocate:
- Piscataway, NJ 08854: Relocate before starting work (Required)
Work Location: In person