As a vital member of the Utilization Management team at CentraCare, the Utilization Case Manager Nurse collaborates with an interdisciplinary team to ensure patient care aligns with the American Case Management Association's Standards of Practice. This role involves managing a designated patient caseload, including those in observation status at St. Cloud Hospital and other CentraCare hospitals.

You will review medical records and interview patients and families to address care progression, transition needs, and manage hospital length of stay. This role also promotes efficient utilization of resources and intervening to remove barriers to timely care delivery and reimbursement. Respecting and valuing contributions from all disciplines, and communicating effectively with patients, families, caregivers, healthcare team members, Physician Advisors, and insurance companies. Building and maintaining relationships that foster trust and confidence.

This role drives change by identifying performance improvement areas and incorporating evidence-based practices. Follows the Nursing Compass: St. Cloud Hospital's Nursing Professional Practice Model to achieve the hospital's mission of improving health and quality of life. Provide age-appropriate care and supporting patient safety and other safety practices. Promote professional growth through mandatory and continuing education and skills competencies. Supports department-based goals that contribute to organizational success.

This role is essential in facilitating patient care and ensuring efficient resource management while upholding the hospital's mission and values.

Schedule:

Full-time | 80 hours every two weeks | St. Cloud Day shift | Monday through Friday | Start times between 7am and 8am

Pay and Benefits:

Starting pay begins at $40.33 per hour; exact wage determined by years of related experience Pay range:  $40.33 - $60.50 per hour Tuition reimbursement and college grant programs available Full-time benefits: Medical, dental, PTO, retirement, employee discounts and more

Qualifications:

Bachelor’s degree or higher in nursing required Registered Nurse (RN) with current license in the State of Minnesota required American Case Management Association Certification (ACMA Accredited Case Manager) required within 2 years from date of hire 2 years minimum of relevant clinical experience or other related experience in any of the following functions: utilization review, performance improvement, quality assurance, risk management or case management related experience is required Acute care clinical experience required Must possess a working knowledge of medical/legal issues in health care with special emphasis on documentation issues Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement is preferred Understanding of pre-acute and post-acute venues of care and post-acute community resources is preferred Knowledge and background with CMS CoP is highly beneficial

CentraCare has made a commitment to diversity in its workforce. All individuals including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.