Ocean Beach Hospital and Medical Clinics is seeking a full-time Utilization Review Nurse!

Build your career with us! We believe in collaborative mentorship in a family feel atmosphere. We are a mission driven non-profit, where we provide compassionate, patient focused care for our community. We value our staff, and our community, and it shows! Unlike the big corporations, we have the time to invest in you and your future. Working for a non-profit also means you would qualify for the Public Service Loan Forgiveness program.

Our website: Ocean Beach Hospital - Health Care for Long Beach, Ilwaco, Oceanview, Ocean Park, Seaview, Chinook

In addition to being part of our amazing staff, you would have the pleasure of living here! The Long Beach Peninsula, in beautiful Pacific County, is located in the very southwest corner of Washington state. It's an easy and scenic drive from both Portland and Seattle as well as a classic Highway 101 destination and part of two scenic byways.

Plan your trip to the Washington Coast - Visit Long Beach Peninsula

Why should you choose us?

• Excellent medical, dental, and vision insurance.
• $10,000 sign-on bonus and relocation assistance available.
• 5 weeks of PTO in your first year.
• 8 paid holidays.
• 8 volunteerism hours.
• Short term disability.
• Retirement plans with a 3% employer match after one year.
• Excellent EAP provider.
• And more!

Education/Experience/Minimum Qualifications:

• Nursing degree from an accredited nursing program
• Current RN license in the state of Washington
• Three years relevant clinical nursing experience
• Recent experience as an inpatient utilization review nurse
• Certified as a case manager preferred
• EPIC experience preferred
• Excellent interpersonal communication, problem-solving, and conflict resolution skills
• Computer skills in word, excel and data base management preferred
• Knowledge in areas of Medicare and Medicaid UM regulations, InterQual, and Denial Management

Job Summary:

• Ensure that all hospitalized patients have the correct admission status so that the appropriate claim can be submitted to commercial and government payers.
• Identify and facilitate resolution of system process problems impeding utilization management functions. Identify and resolve delays and obstacles as appropriate.
• Collaborate with nursing, providers, fiscal, coding, and billing staff to answer clinical questions related to medical necessity and patient status.
• Facilitate the daily UR meetings and the quarterly UR meetings with physicians.
• Assist with preparation of discussion and appeal letters for Medicare/Medicaid medical necessity denials
• Other audit activities as requested
• Provide clinical consultation regarding utilization management to providers.
• Interact with providers, nurses, and other hospital colleagues in a timely, positive manner to resolve utilization management and patient status issues.
• Use Microsoft Word, Excel, PowerPoint, and other software tools for analysis and presentation of utilization review related data.
• Create reports, displaying data and providing narrative analysis, to a variety of audiences.
• Demonstrates commitment to the team and serves as a mentor to co-workers.

Have questions? Please contact HR at employment@oceanbeachhospital.com.