Utilization Management RN

At North Memorial Health, you’re part of an inclusive health team that is rooted in our values:
Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North’s culture which is designed to actively support each team member’s wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health.

Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center.

Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women’s Choice Award Best Hospitals list.

As North Memorial Health is a non-profit organization you are eligible for the Public Student Loan Forgiveness program. Most part-time and all full-time positions are eligible for benefits.

• Health & Welfare Benefit Packages
• 401k Retirement Match or Pension Plan, based on workgroup eligibility
• Generous Paid Time Off (PTO) Plans
• Adoption Reimbursement up to $3000 per child
• Child Care Discount Program with New Horizon 10% off weekly childcare tuition
• Education/Tuition Reimbursement
• 24/7 Fitness Center Access for all benefit eligible team members

At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients.

We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.

The Utilization Management RN, under the supervision of the Utilization Management Manager, acts as a support resource to the Medical Staff of North Memorial Health (NMH) and Maple Grove Hospital (MGH) in relationship to clinical documentation of admitted customers. The UM RN assess the documented medical necessity of each bedded patient to assist the MD as needed to determine an appropriate admission status.

They provide clinically based information to assist with care coordination and support the delivery of quality customer care as efficiently as possible. The RN has accountability for assisting in ensuring quality clinical outcomes, and appropriate resource management related to admission, readmission, length of stay, extended stay, avoidable days and discharge planning. They work with the medical and care teams (nursing, social services, therapies, and ancillary departments) to ensure the customer is receiving the right care, at the right level across the continuum.

Additionally, they know the disease, trajectory of illness, treatment plan, standard of care for the diagnosis, expected outcome, and Length of Stay (LOS) for the case type. They work with all admissions (bedded customers) excluding any customers in the Emergency Department Finally, they UM RN actively and consistently demonstrates the mission, vision, values and guiding principles of North Memorial Health.

• Bachelor's Degree from an accredited school of nursing required.

• Three (3) to five years of previous acute care nursing experience required.
• One (1) year of direct case management experience required.
• Hospital case management and utilization management experience required.
• Knowledge of nursing theory and practice and primary care principles and practices.
• Knowledge of Medicare rules and…