Registered Nurse Utilization Management

As a Registered Nurse Utilization Management at Select Health, your main responsibilities include overseeing inpatient and outpatient care, ensuring that services provided align with insurance benefits, and applying clinical expertise to review medical records. You will need to engage proactively with members and providers, manage authorizations, and ensure compliance with regulatory guidelines. Your role is crucial in facilitating safe and efficient medical care while collaborating with care teams to meet the unique needs of each member.

To qualify as a Registered Nurse Utilization Management at Select Health, you need a current RN compact license, at least one year of experience in care management or a related field, and strong communication skills. While a BSN is preferred, it must be obtained within three years of your hire or promotion to this position. Additional qualifications include experience in Utilization Management or working with third-party payers, as well as the ability to adapt in a fast-paced environment.

Yes, Select Health offers comprehensive training for new Registered Nurse Utilization Management staff. The first 4-6 weeks of your role will be conducted in the office to help you assimilate with the team, familiarize yourself with policies and procedures, and fully understand your responsibilities. This training ensures that you are well-equipped to handle the demands of the position and provide optimal care for our members.

Essential skills for a Registered Nurse Utilization Management at Select Health include strong clinical expertise, investigative acumen, excellent verbal and written communication abilities, and effective problem-solving skills. Additionally, you'll need good time management competencies and the capability to work autonomously while adapting to changes in a fast-paced healthcare environment.

The work environment for a Registered Nurse Utilization Management at Select Health is supportive and flexible. Initially, new hires will work onsite in the Nevada Central Office, transitioning to a hybrid model after training. The role often involves collaborating with a diverse team including physicians, facilities, and care teams, providing an engaging and dynamic workplace focused on the overall well-being of our members.

When answering this question, emphasize your passion for patient care and how your skills align with the mission of Select Health. You might mention your commitment to quality, community health, or your desire to work in a collaborative environment.

In your answer, provide specific examples of your past roles in Utilization Management. Discuss how you reviewed medical necessity, applied evidence-based guidelines, and collaborated with care teams to optimize patient care. Highlight any relevant metrics or outcomes from your work.

You could explain your approach, such as standardizing communication checks, being clear and concise, and using active listening techniques. Giving examples of how you resolved misunderstandings or improved processes in past roles would benefit your response.

Here, discuss your time management techniques, such as setting daily goals, using to-do lists, or applying prioritization frameworks. Mentioning how you adapt to changes in workload or unexpected situations can emphasize your flexibility.

You might want to talk about your methods for continued education, such as attending professional conferences, reading relevant journals, or participating in training programs. Showing a proactive approach to your professional development is essential.

Choose an example that showcases your problem-solving skills, emotional intelligence, and the outcome of your actions. Describe the dispute, how you approached the resolution, and what you learned from the experience.

Emphasize the importance of collaboration in achieving optimal patient outcomes. Provide examples of how you've worked positively with others, resolved conflicts, and contributed to team-oriented successes.

Discuss your conflict resolution skills, emphasizing communication and empathy. Provide examples to illustrate how you've turned potentially contentious situations into productive discussions.

Here, demonstrate your knowledge of clinical guidelines, regulations, and the importance of individualized patient assessments. You can reference specific criteria or tools like InterQual to support your viewpoint.

Explain how patient education can enhance compliance, lead to better health outcomes, and decrease unnecessary hospitalizations. Use examples from your experience where patient education made a difference.