[Hiring] Utilization Registered Nurse @TriHealth

Role Description

Join Our Team as a Utilization Nurse! At TriHealth, we are driven by a shared commitment to excellence and innovation in healthcare. We believe that every test, analysis, and result plays a vital role in our mission to provide the highest standard of care to our patients. Join us in our mission to advance healthcare and improve lives. Apply today and be part of a team that is passionate about making a difference.

Job Overview:

• This position reports to the supervisor or manager of Utilization Management.
• The Utilization Management (UM) Nurse is responsible for evaluation of medical necessity to ensure care is delivered at the appropriate level, and aligns with regulatory and payer requirements.
• The UM Nurse collaborates with physicians, care management, and payers to ensure authorization of provided services.
• Knowledge of computer programs such as Microsoft Outlook, Microsoft Word, TEAMS, EPIC, and Voalte is required.
• Working autonomously is necessary, so strong time management and self-discipline are essential characteristics for candidates.

Qualifications

• Associate's Degree - Nursing (Required)
• New hires required to obtain BSN within 5 years of hire (Required)
• 3 - 4 years of clinical experience in nursing (Required)
• Membership in related professional organization (Preferred)

Requirements

• Specialty Patient Care Guidelines
• Basic computer skills
• Problem solving
• Establish effective working relationship with members of healthcare team and external customers
• Prior experience in self-directed position
• Registered Nurse Upon Hire Required

Benefits

• Comprehensive benefits package, including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement.

Working Conditions

• Bending - Rarely
• Climbing - Rarely
• Concentrating - Consistently
• Continuous Learning - Consistently
• Hearing: Conversation - Consistently
• Hearing: Other Sounds - Consistently
• Interpersonal Communication - Consistently
• Kneeling - Rarely
• Lifting <10 Lbs. - Frequently
• Lifting 50+ Lbs. - Rarely
• Lifting <50 Lbs. - Rarely
• Pulling - Rarely
• Pushing - Rarely
• Reaching - Frequently
• Reading - Consistently
• Sitting - Consistently
• Standing - Occasionally
• Stooping - Rarely
• Talking - Consistently
• Thinking/Reasoning - Consistently
• Use of Hands - Consistently
• Color Vision - Frequently
• Visual Acuity: Far - Occasionally
• Visual Acuity: Near - Frequently
• Walking - Occasionally

TriHealth SERVE Standards and ALWAYS Behaviors

• Serve: ALWAYS welcome everyone by making eye contact, greeting with a smile, and saying "hello".
• Excel: ALWAYS recognize and take personal responsibility to address and recover from service breakdowns.
• Respect: ALWAYS respect cultural and spiritual differences and honor individual preferences.
• Value: ALWAYS value the time of others by striving to be on time, prepared, and actively participating.
• Engage: ALWAYS acknowledge wins and frequently thank team members and others for contributions.