The Medical University of South Carolina is seeking a Utilization Management Nurse II with a focus on surgical patients. This role requires a strong nursing background with experience in utilization and case management, particularly in a hospital setting
Job Summary
The Utilization Management Nurse functions as a member of the clinical service line team to facilitate optimal reimbursement through accurate certification of assigned patients.
This position conducts initial admission reviews and refers cases for secondary review when appropriate, ensuring adherence to regulatory requirements with Medicare, FFS Medicaid, and other government payers.
The UM Nurse refers and consults with the multidisciplinary team to promote appropriate communication of review results to hospital revenue professionals to ensure proper utilization of hospital resources for accurate reimbursement.
Matching Summary
Match Score: 75
The Medical University of South Carolina is seeking a Utilization Management Nurse II with a focus on surgical patients. This role requires a strong nursing background with experience in utilization and case management, particularly in a hospital setting.
Skills & Requirements
Must-have
utilization reviews
patient chart monitoring
treatment plan review
payer approval status
multidisciplinary team consultation
Nice-to-have
energetic enthusiastic individuals
leadership coverage
learn new processes tools
Key Requirements
Bachelor's degree in Nursing
five years of nursing work experience
two years utilization / case management experience
Prior leadership experience preferred
Evidence of committee involvement
Licensure as a registered nurse by the state of South Carolina or compact state