Supervisor, Utilization Review, RN

Company: Seattle Children's
Location: Seattle
Posted on: February 16, 2020

Job Description:

About UsHope. Care. Cure. These three simple words capture what we do at Seattle Children---s ---- to help every child live the healthiest and most fulfilling life possible. Are you ready to engage with a mission-driven organization that is life-changing to many, and touches the hearts of all? #HOPECARECURE--Our founding promise to the community is as valid today as it was over a century ago: we will care for all children in our region, regardless of the families--- ability to pay. Together, we deliver superior patient care, advance new discoveries and treatments through pediatric research, and serve as the pediatric and adolescent, academic medical center for Washington, Alaska, Montana and Idaho --- the largest region of any children---s hospital in the country.--In 2019, U.S. News & World Report once again ranked Seattle Children---s among the nation's best children's hospitals --- for the 27th year in a row. We received national rankings in all 10 specialty areas evaluated by U.S. News & World Report, and are honored to be the only pediatric medical center in Washington to be ranked.--As a Magnet designated institution, and classified among America---s best large employers by Forbes, we recognize the importance of hiring and developing great talent to provide best-in-class care to the patients and families we serve. Our organizational DNA takes form in our core values: Compassion, Excellence, Integrity, Collaboration, Equity and Innovation. Whether it---s delivering frontline care to our patients in a kind and caring manner, practicing the highest standards of quality and safety, or being relentlessly curious as we work towards eradicating childhood diseases, these values are the fabric of our culture and community. The future starts here.OverviewProvide supervision and leadership for the day-to-day operations and activities of the Utilization Management department. Responsibilities include personnel management, modeling excellent service quality standards, implementing continuous improvement initiatives, providing clinical management and expertise, and maintaining or supporting systems used by the Utilization Management Department.RequirementsRequired Education/Experience: - BSN required. - Minimum three years of inpatient acute care nursing experience, preferably in pediatrics. - Minimum three years of relevant authorization, utilization review, case management, or denial management experience, either at a health plan or within a health care delivery system. - Minimum two years in a progressively responsible leadership role. Required Credentials: - Current Washington State RN licensure. - Current Basic Life Support (BLS) for Healthcare Providers. Pediatric Emergency Assessment, Recognition and Stabilization (PEARS), and Pediatric Advanced Life Support (PALS) will be accepted in lieu of BLS for Healthcare Providers. Employees are responsible for any costs (including time away from work) associated with obtaining PALS or PEARS certification. Preferred: - Five years experience with insurance authorization and/or utilization review processes. - Five years inpatient pediatric nursing experience. - Demonstrated competency with the use of MCG and Interqual criteria sets. - Knowledge of health care funding with previous experience working with or for health insurance carriers, preferably in a utilization management role. - Case Management Certification.Our Commitment to DiversityOur community welcomes diverse experiences, backgrounds, and thoughts as this is what drives our spirit of inquiry and allows us to better connect with our increasingly diverse patients and families. Our organization recruits, employs, trains, compensates, and promotes without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. --The people who work at Seattle Children---s are members of a community that seeks to respect and celebrate all the qualities that make each of us unique. Each of us is empowered to be ourselves within this community, which cultivates and promotes equity, diversity, and inclusion at all levels. --Seattle Children---s is proud to be an Equal Opportunity Workplace and Affirmative Action Employer.

• Area of Interest: Utilization Review;
• FTE/Hours per pay period: 1.0 FTE (80 hours per bi-weekly pay periods);
• Work Status: Regular;
• Department: Utilization Review;
• Shift: Day Shift;
• Job ID: 34903;

Keywords: Seattle Children's, Seattle , Supervisor, Utilization Review, RN, Healthcare , Seattle, Washington