Job Title: RN – Unit Manager (Utilization Management)
Location: Jersey Shore, PA 17740
Schedule: Monday to Friday | 7:00 AM – 3:30 PM
Pay Rate: $50 to $54/hour
Position Type: Contract
Job Summary:
We are seeking an experienced Registered Nurse (RN) Unit Manager to join the Utilization Management (UM) team. The ideal candidate will review patient records, coordinate with care teams, and ensure services meet clinical, regulatory, and insurance standards—all while maintaining the highest level of patient advocacy and operational efficiency.
Key Responsibilities:
Review patient medical records to confirm medical necessity and alignment with clinical guidelines.
Collaborate with physicians and interdisciplinary teams to develop, monitor, and optimize care plans.
Analyze the utilization of healthcare services to promote cost-effective, high-quality care.
Liaise with insurance providers to facilitate authorizations and approvals for medical procedures and treatments.
Conduct pre-authorization and concurrent reviews to confirm appropriateness of services and coverage.
Educate patients and families about care plans, treatment options, and insurance processes.
Document utilization data accurately in the hospital's electronic medical record (EMR) system.
Ensure compliance with legal, regulatory, and accreditation standards as well as payer policies.
Communicate and resolve issues with healthcare providers regarding medical necessity and coverage.
Support discharge planning to ensure smooth transitions to appropriate post-acute care settings.
Qualifications:
Registered Nurse (RN) license – active and in good standing in the state of Pennsylvania (or compact license if applicable)
BLS Certification (American Heart Association preferred)
Minimum 1–2 years of experience in Utilization Management or Case Management
Strong knowledge of clinical care guidelines, insurance authorization processes, and discharge planning
Excellent communication, documentation, and organizational skills
Experience with EMR systems and utilization tracking tools