Utilization Management Nurse
LOCATION: Akron, Ohio
CATEGORY: nursing
Overview
At Akron Children’s, careers in nursing feel different. You make an impact on a daily basis, face-to-face, on children and their families. You do much more than treat patients. As the individual your patients come to recognize, rely on and smile at, you go beyond the title of nurse. Because this is more than a job. It’s what you were meant to do.
Success Profile
What makes a successful nurse at Akron Children's? Check out the top traits we’re looking for and see if you have the right mix.
- Compassionate
- Helpful
- Personable
- Positive
- Sincere
- Understanding
Job Description
Job Requisition Number 35479Full Time Days
7am-4:30pm
40 Hours/Week
Utilization management and pediatric nursing experience preferred
Summary:
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices.
Responsibilities:
1. Conduct Utilization Review & Determine Appropriate Level of Care
Applies evidence‑based medical necessity criteria, validates admission status, and ensures all inpatient, observation, and outpatient-in-a-bed cases meet criteria. Collaborates proactively with physician advisors and attending providers for accurate level‑of‑care decisions and authorization of hospital days.
2. Manage Denials, Compliance, and Quality Improvement Activities
Participates in denial management and peer review processes, identifies compliance or ethical issues, and contributes to quality and safety initiatives aimed at improving departmental and hospital workflows.
3. Support Care Progression Through Interdisciplinary Collaboration
Actively engages in daily huddles, multidisciplinary rounds, and patient care discussions to understand service intensity, discharge barriers, and progression of care, while serving as a resource to the care team on utilization, documentation, and admission requirements.
4. Maintain Accurate and Timely Documentation
Clearly documents all reviews, interactions, and decisions in Midas, Epic, and other required systems.
5. Performs additional duties as assigned.
Other information:
Technical Expertise
1. Experience in inpatient clinical is required.
2. Experience in pediatrics is preferred.
3. Experience working with all levels within an organization is required.
4. Experience in healthcare is required.
5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required.
Education and Experience
1.Education: Bachelor's in nursing [BSN] is required. For employees hired after July 1, 2013, BSN is required or must be obtained within 5 years from date of hire.
2. Certification: Registered Nurse licensure is required.
3. Years of relevant experience: 3 years is required.
4. Years of experience supervising: None.
Full Time
FTE: 1.000000
Status: Remote
Grow Your Career with Akron Children’s
Here at Akron Children's, we offer many ways for our nurses to succeed and grow professionally. There are multiple ways to grow your nursing career into areas such as leadership, education/professional development, advanced practice, informatics, research, quality, and more.
Benefits
Benefits for Akron Children’s team members go far beyond their compensation. Our comprehensive benefits program offers coverage, connections and resources that enable you to live your best life while growing your career.
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Nurse Residency
Program -
Health and
Wellness Programs -
Education
Assistance -
Career
Development -
Ascend
Program -
Awards and
Recognition
Employee Highlight
What inspires me as a nurse manager is my team of staff nurses and how dedicated they are. It doesn't matter how busy we are. They work and continue to work until the job is done.Karan Johnson
Nurse Manager, Adolescent Unit
Our Promises
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To treat every child as we would our own.
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To treat others as they would like to be treated.
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To turn no child away.
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