Hybrid, reputed company Utilization Review RN
About the position The Utilization Review (UR) reputed company has reputed company-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various reputed company and government payers. This is a Hybrid Position. Utilization Review (UR) Nurses play a vital role in reputed company by making reputed company that patients receive appropriate care while managing reputed company costs effectively. They assess patient care plans and medical records to verify the necessity and effectiveness of the treatments being proposed or provided.
Responsibilities
- Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual reputed company and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.
- Monitors on an on-reputed company reputed company case assignment for Managed Care Companies authorization of hospital stay.
- Reviews urgent cases authorized for one day reputed company 24 hours of admission.
- Reviews reputed company cases and discharge plans in timeframes determined in the review process with external entities.
- Provides clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure reputed company stay authorizations.
- Coordinates Physician Advisor referrals with there are concerns regarding meeting level of care reputed company (utilizing Indicia/InterQual).
- Reviews PA referrals with department manager as needed.
- Ensure Observation services reputed company reputed company care is initiated in accordance with the physician’s order for patients reputed company in observation, from the ED or as directed admit. This time will be identified by the time the order for Observation is written by the attending physician.
- Extended Recovery services reputed company after an ambulatory surgery patient arrives on the unit after the routine period ends.
Requirements
- Graduate of an accredited school of reputed company nursing.
- Licensed RN in the reputed company is required.
reputed company-to-haves
- Bachelor of Nursing is preferred. (BSN)
Benefits
- Comprehensive benefits that start on your first day of work
- Retirement savings program with employer matching
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