Sr. Inpatient Utilization Management Nurse

Job Description

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking two (2) Sr. Inpatient Utilization Management Nurses to join our team.

Primary Responsibilities:

Perform Utilization Review of admissions and/or continuing inpatient stay by utilizing standardized clinical criteria as well as the DSS contractual definition of Medical Necessity.

Discuss clinical reviews with Medical Reviewers as needed.

Tasks Performed:

Presents summarized information to medical reviewers when second level review is necessary.

Makes referrals to intensive case management and the behavioral health ASO when appropriate.

Identifies and refers quality of care issues as part of admission and continued stay reviews.

Acts as preceptor to new staff.

May be asked to support other areas of the UM department including performing first level medical necessity reviews for elective inpatient admissions and outpatient services.

Performs other duties as assigned.

Essential Functions:

Conducts clinical review for members receiving care in an inpatient setting.

Requires the ability to efficiently filter through large amounts of clinical data, to obtain pertinent information based on condition and presentation, applying clinical guidelines to facilitate appropriate decision making without compromising accuracy.

Reviews the appropriateness and medical necessity of admissions utilizing InterQual criteria.

Makes first level approval determinations and appropriately refers cases to Medical Director for second level review when case does not meet InterQual criteria.

Desired Education: Two to four years post-secondary schooling

Desired Degree: Bachelor's degree preferred

Desired Major: Nursing

Desired Job Experience: Three to five years' related experience with at least three years of clinical experience. Managed care experience preferred.

Other Qualifications: Experience with InterQual criteria preferred. Knowledge of Medicaid preferred. Strong verbal and written communication skills. Excellent organizational skills, ability to manage multiple priorities concurrently. Strong computer and keyboard skills. Ability to exercise independent and sound judgment in decision making. Team player. Connecticut RN license must be current and unrestricted.

Certifications Required: Active Registered Nurse License

CHNCT Offers Great Benefits:

Medical, dental and vision coverage options

Flexible spending and health savings accounts

Group term life insurance

A 401(k) plan with company-match and immediate vesting

Voluntary accidental injury coverage

Tuition reimbursement and continuing education opportunities

A generous paid-leave bank and company holidays

Wellness program

We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value of our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.

Full-time