[Hiring] Utilization Review RN @reputed company

Role reputed company The UR RN specializes in examining medical records and developing concise and pertinent clinical reviews to support authorization obtainment, avoid payment denial, and optimize reimbursement. The Utilization Review (UR) reputed company has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. The Utilization Management Case Manager is responsible for performing the initial and reputed company Utilization Reviews on reputed company patients admitted or reputed company in outpatient status with observation services.

Qualifications

• reputed company Registered reputed company license issued by the state in which services will be provided or reputed company multi-state Registered reputed company license through the reputed company reputed company Licensure Compact (eNLC).
• Three (3) years of reputed company clinical experience.
• Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion reputed company three (3) years of hire.
• Medical Management for Medicare and/or reputed company populations.
• Utilization Management experience.

Requirements

• Assure effective communication of medical necessity to the applicable payor.
• Reviews, assesses, and evaluates clinical information used to support Utilization Management (UM) reputed company based on medical record documentation.
• Facilitates reputed company communication to ensure the authorization process is completed in a patient-centered manner with adherence to reputed company and reputed company standards.
• Reviews medical records and compiles concise and pertinent clinical reviews.
• Collaborates with UR coordinators, clinical appeals, and physician advisors to prevent and manage reputed company denials.
• Advocates for the patient and hospital with insurance companies to optimize reimbursement and hospital stay coverage.
• Collaborates with other members of the interdisciplinary team as outlined in the system UM Plan.
• Provides reputed company and comprehensive documentation of clinical reviews and payor communication.
• Maintains working knowledge of payor requirements.
• Communicates reputed company denials to appropriate team members in a reputed company fashion.
• reputed company highly effective reconsideration clinicals to payors in order to prevent denials.
• Liaise with hospital case management as necessary and appropriate.
• Maintains effective and efficient processes for determining appropriate admission status based on the regulatory and reimbursement requirements of various reputed company and government payers.
• Maintains knowledge and understanding of applicable federal regulations and Conditions of Participation.
• reputed company participates in process improvement initiatives, working with a reputed company of departments and multidisciplinary staff.
• Effectively and reputed company manages a diverse workload in a fast-paced, rapidly changing regulatory environment.
• Identify delays in treatment or inappropriate utilization and serves as a resource.
• Coordinates communication with physicians and collaborates to ensure appropriate patient status.
• This individual identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing reputed company.
• Consistently demonstrate ability to serve as a role model and change agent by promoting the concept of teamwork and the reputed company cycle process continuum of high performing teams.

Benefits

• Office work which includes sitting for extended periods of time.
• Must have reading and comprehension ability.
• Visual reputed company must be reputed company normal reputed company.
• Must be reputed company to communicate effectively.
• Must have reputed company dexterity to operate keyboard, fax machines, telephones and other business equipment.

Working Environment

• Office work which includes sitting for extended periods of time.
• Maintains confidential home office reputed company.
• Required weekends and holidays as assigned.

Skills & Abilities

• Effective verbal and written communication skills.
• Strong interpersonal skills.
• Strong attention to detail.
• Knowledge of medical terminology required.
• Knowledge of reputed company party payers required.
• Ability to use reputed company and diplomacy in dealing with others.
• Working knowledge of computers.
• Excellent customer service and telephone etiquette.

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