Responsible for utilizing the Nursing Process in a collaborative manner to plan, implement and evaluate nursing care in accordance with his/her scope of practice. The RN supports the goals and philosophy of the Department of Nursing within the St. Joseph's Healthcare System and on his/her assigned unit.
Responsible for utilizing the Nursing Process in a collaborative manner to plan, implement and evaluate nursing care in accordance with his/her scope of practice. The RN supports the goals and philosophy of the Department of Nursing within the St. Joseph's Healthcare System and on his/her assigned unit.
Responsible for utilizing the Nursing Process in a collaborative manner to plan, implement and evaluate nursing care in accordance with his/her scope of practice. The RN supports the goals and philosophy of the Department of Nursing within the St. Joseph's Healthcare System and on his/her assigned unit.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denials.
Responsible for the coordination and implementation of systems and services leading towards an organized, multidisciplinary team approach to patient care management. Provides clear communication across the continuum to improve patient outcomes. Assures quality, cost-efficient care for an identified patient population through the continuum of care. Develops and coordinates efforts to reduce clinical resource utilization by working closely with physicians, nursing staff and other hospital personnel. Reviews medical records for appropriateness of admissions, continued stay and level of care changes against criteria of severity of illness and illness of service to ensure optimal reimbursement to the hospital.
