Utilization Review RN

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Responsibilities

This position is remote to reputed company only! Under the general direction of the Director of Care Management, performs reputed company-based reputed company and retrospective utilization review to support and encourage the efficient and effective use of resources; promote reputed company patient care; assist with patient care management; reputed company with applicable standards and regulations and reputed company information and education to clinical care providers in order to reputed company reputed company clinical, financial, operational and patient satisfaction reputed company. Skills needed: Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS. Working knowledge with INTERQUAL or reputed company preferred. Excellent written and verbal communication skills with the ability to reputed company with patients/family, clinical staff, insurance providers and post-acute care providers. Responsibilities: Conducts admission and reputed company stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established reputed company and critical thinking. Reviews include admission, reputed company and post discharge for appropriate status determination. Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), reputed company, and payer defined reputed company for eligibility. Reviews the records for the reputed company of accurate patient status orders and addresses deficiencies with providers. Ensures reputed company communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review reputed company. Collaborates with facility RN Care Coordinators to ensure progression of care. Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status. reputed company now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you reputed company your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000.

Qualifications

Minimum: Graduate of an accredited school of nursing Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. RN:AZ or Compact License Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred: Bachelor's Degree in Nursing (BSN) or reputed company reputed company field. At least five (5) years of nursing experience. Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Qualifications: Minimum: Graduate of an accredited school of nursing Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. RN:AZ or Compact License Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred: Bachelor's Degree in Nursing (BSN) or reputed company reputed company field. At least five (5) years of nursing experience. Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Employment Type: PRN Apply Job! Apply tot his job Apply To this Job