Utilization Management Nurse Specialist

Are you a dedicated and compassionate healthcare professional looking for a challenging and rewarding career opportunity? Look no further than Presbyterian Healthcare Services! We are currently seeking a Utilization Management Nurse Specialist to join our dynamic team of professionals. In this role, you will be responsible for ensuring the appropriate utilization of healthcare services for our patients, while also promoting efficient and effective delivery of care. If you have a passion for improving patient outcomes and possess the necessary qualifications, we encourage you to apply for this exciting position.

1. Conduct utilization reviews to ensure the appropriate utilization of healthcare services for patients.
2. Evaluate medical necessity and appropriateness of treatment plans and make recommendations for alternative or additional services as needed.
3. Collaborate with healthcare providers to develop and implement care plans that promote efficient and effective delivery of care.
4. Monitor and track patient outcomes to identify areas for improvement and make recommendations for process enhancements.
5. Stay up-to-date on healthcare industry regulations and guidelines to ensure compliance in all utilization management activities.
6. Communicate with insurance companies and other third-party payers to obtain pre-authorization for services.
7. Educate healthcare providers and staff on utilization management processes and best practices.
8. Participate in quality improvement initiatives and provide input on policies and procedures related to utilization management.
9. Document all utilization management activities in a timely and accurate manner.
10. Collaborate with other healthcare professionals, such as case managers and social workers, to coordinate care and ensure seamless transitions for patients.

According to JobzMall, the average salary range for a Utilization Management Nurse Specialist in Albuquerque, NM, USA is between $71,000 and $106,000 per year. This range can vary depending on factors such as experience, education, and specific job responsibilities.

Presbyterian Healthcare Services is a private not-for-profit health care system and health care provider in the State of New Mexico. It owns and operates 8 hospitals in 7 New Mexico communities. It also operates Presbyterian Health Plan.