Provide inpatient nurse care management and utilization review for hospitalized medical and surgical patients, with primary coverage across inpatient units and rehab care management. The role focuses on preadmission, concurrent, retrospective, admission, observation, and continued-stay reviews to support medical necessity, appropriate status assignment, and discharge planning.
Key Responsibilities
- Conduct preadmission, concurrent, and retrospective reviews using objective quality, coding, and medical necessity criteria.
- Provide inpatient care management for hospitalized medical and surgical patients.
- Coordinate daily interprofessional rounds, discharge goals, anticipated discharge dates, and barriers to discharge.
- Communicate review findings and patient progress to nursing, social work, providers, and other team members.
- Assist with insurance utilization review, including status review, follow-up on incomplete reports, and appeal support when payment is denied.
- Use the electronic health record to document reviews and support admission, observation, and continued-stay decisions.
- Analyze data and contribute to process improvement, quality outcomes, and financial stewardship efforts.
- Participate in ongoing education and training to maintain utilization review and management competence.
Required
- Current RN license through the Minnesota Board of Nursing.
- Bachelor’s degree, preferably in nursing or a related healthcare field.
- Current BLS certification through the American Heart Association, or ability to obtain within 90 days of hire.
- At least 5 years of recent clinical experience.
- Interest in working with people with short-term or long-term disabilities that begin in childhood.
Preferred
- Master’s degree in nursing or a related field.
- Certification in a specialty area, such as URAC certification.
- Knowledge of utilization review and utilization management.
- Leadership experience.
Benefits & Perks
- .8 FTE schedule, Monday through Friday, 8:00am to 4:30pm.
- Coverage across inpatient units with rehab care management support.
- Annual salary range of $95,222.40 to $142,792.00.
- Retirement savings match.
- Tuition and certification reimbursement.
- Paid time off.
- Health and wellness benefits for .5 FTE and above.