What are the responsibilities and job description for the Utilization Management Nurse position at Cherry Blossom PACE?
Cherry Blossom PACE provides integrated medical and social services to our most vulnerable seniors, helping to unlock their full potential. We are looking for team members who are energized by working in diverse teams toward our shared purpose. Those eager to drive groundbreaking innovation, and who will interact with those we serve and those who serve them in a spirit of understanding and compassion.
WHAT WE OFFER
- Competitive pay, retention and referral bonuses
- Outstanding Medical, dental, and vision insurance
- Paid day off for your birthday
- 401K Company match on day one
- Company paid life insurance
- Generous PTO
- Career development opportunities
- Employee Recognition
#PACE
Qualifications:Job Summary:
The RN Utilization Management Nurse, under the general direction of the PACE Clinic Manager, is responsible for performing clinical utilization management activities, ensuring appropriate delivery of care, compliance with regulatory requirements, and efficient use of healthcare resources. This role combines direct clinical review and care coordination with limited short-term supervisory responsibilities for clinical staff.
Required Skills/Abilities:
- Strong knowledge of utilization management, case management, and population health concepts.
- Excellent verbal and written communication skills.
- Strong interpersonal and customer service skills, with the ability to build trust and rapport with staff, participants, and families.
- Ability to navigate communications with large medical networks, including hospitals, specialist offices, and others.
- Analytical and problem-solving skills with attention to regulatory compliance.
- Ability to function effectively in a fast-paced and agile environment.
- Proficiency with Microsoft Office Suite and electronic health record systems.
Education, Licenses, Certifications and Experience:
- Current Registered Nurse (RN) license (required).
- CPR/BLS certification (required).
- Prior experience in utilization management, case management, or quality review (required).
- At least 2 years of clinical nursing experience (PACE, geriatrics, or aging care management preferred).
- Leadership or supervisory experience helpful but not required.