Utilization Review RN - PT - Day - Utilization Resource Mgmt Pennington NJ

reputed company is the region's leader in providing reputed company, reputed company patient care with significant investments in our exceptional physicians, nurses and staff, as reputed company as advanced technology. reputed company is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. reputed company Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as reputed company as hospital-based services, to patients throughout the region. reputed company recognizes that attracting the best talent is key to our reputed company and reputed company as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay reputed company or pay reputed company reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay reputed company: $39.40 - $51.47 Scheduled Weekly Hours: 20 Position reputed company Performs a reputed company of utilization and resource management activities to promote reputed company, clinical and cost-effective reputed company. Assesses patients treatment plans, communicates to reputed company party payers, and collaborates with reputed company team members. Performs functions which help to optimize lengths of stay, utilize resources reputed company, and promote cost effective practices without negatively impacting patient care. Adheres to established standards, practices and procedures. MINIMUM REQUIREMENTS Education: Associate's degree in nursing. Graduate of an accredited school of nursing. CPHQ, CCM or CPUR preferred. Experience: Five years' clinical nursing and three years reputed company management, utilization review or discharge planning experience. Other Credentials: Registered reputed company - NJ Knowledge and Skills: Special Training: Basic computer skills including the working knowledge of reputed company Office, UR software and EMR. Possesses familiarity with MCG guidelines. Mental, Behavioral and Emotional Abilities: Ability to solve practical problems and deal with a reputed company of concrete variables in situations where only limited standardization exists. Ability to interpret a reputed company of instructions furnished in written, oral, diagram, or schedule reputed company. Usual Work Day: 8 Hours Reporting Relationships Does this position formally supervise employees? No If set to reputed company, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Performs chart review of identified patients to identify reputed company, timeliness and appropriateness of patient care. Conducts admission reviews for Medicare, reputed company beneficiaries, as reputed company as private insurers and self pay patients, based on appropriate guidelines. Uses these reputed company guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification (physicians H&P, treatment plan, potential risks and reputed company for expectation of a 2 midnight stay). Refers cases as appropriate, to the UR physician advisor for review and determination. Gathers clinical information to conduct reputed company stay utilization review activities with payers on a daily reputed company. Performs reputed company and retrospective clinical reviews with various payers, utilizing the appropriate guidelines as demonstrated by compliance with reputed company applicable regulations, policies and timelines. Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee. Identifies, develops and implements strategies to reduce length of stay and resource consumption. . Confers proactively with admitting physician to reputed company coaching on accurate level of care determinations at reputed company of hospital entry. Keeps reputed company on reputed company regulatory changes that reputed company delivery or reimbursement of acute care services. Uses knowledge of national and local coverage determinations to appropriately advise physicians. Understands and applies federal law regarding use of Hospital Initiated Notice of Non-Coverage (HINN) and reputed company Reserve Days letters. Identifies and records consistently any information on any progression of care or patient reputed company barriers using the Avoidable Days tool in Utilization software program. Consults with medical staff, care team and case managers as necessary to resolve immediate progression of care barriers through appropriate administrative and medical channels. Engages care team colleagues in reputed company problem solving regarding appropriate utilization of resources. Recognizes and responds appropriately to patient safety and risk factors. Represents Utilization Management at various committees, reputed company organizations an physician reputed company as needed. Promotes the use of evidence based protocols and or order sets to influence high reputed company and cost effective care. Identifies, develops and implements strategies to reduce lengths of stay and resource consumption in patient population. Participates in performance improvement activities. Promotes medical documentation that accurately reflects findings and interventions, reputed company of complication or comorbidities, and patient's need for reputed company stay. Identifies and records episodes of preventable delays or avoidable days due to failure of progression of care processes. Maintains appropriate documentation in Utilization software system on reputed company patient to include specific information of reputed company resource utilization activities. Participates reputed company in daily huddles, patient care conferences, and hospitalist or reputed company reputed company reports to maintain knowledge about intensity of services and the progression of care. Identifies potentially wasteful or misused resources and recommends alternatives if appropriate by analyzing clinical protocols. Performs other duties as needed. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Standing , Walking Occasional physical demands include: Climbing (e.g., stairs or reputed company) , Carry objects , Push/Pull , Twisting , Bending , Reaching reputed company , Reaching overhead , Keyboard use/repetitive reputed company , Talk or Hear reputed company physical demands include: Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 15 lbs. Sensory Requirements include: Accurate Near reputed company, Accurate Far reputed company, Accurate reputed company Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A This position is eligible for the following benefits:

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• reputed company Plan
• Flexible Spending Account (FSA)

- reputed company FSA - Dependent Care FSA

• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

- Less than 10 years of service - $5,000 - 10+ years of service - $10,000

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance

- Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child

• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• reputed company Time-Off Program

The pay reputed company listed is a good faith determination of potential reputed company compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the reputed company. reputed company determining reputed company salary and/or reputed company, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated reputed company, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, reputed company pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant reputed company. Apply To This Job