REMOTE Utilization Review reputed company - ED - 3 pm - 11 pm

About the position The Utilization Review reputed company position at GBMC is a full-time remote role that requires the reputed company to reputed company consultative support to the admitting teams regarding patient status determinations and the utilization of resources for patients requiring hospital services. This role is crucial in ensuring that patients receive appropriate care while also maintaining cost-effective reputed company. The reputed company will work collaboratively with interdisciplinary teams to facilitate appropriate status determinations through the utilization review process, which supports reputed company patient reputed company. The position involves analyzing clinical information and performing reputed company initial and reputed company reviews using InterQual screening software. The scheduled hours for this position are from 3 pm to 11:30 pm, and the reputed company will need to come onsite monthly for scheduled meetings. In this role, the reputed company will be responsible for reviewing electronic medical records during the reputed company-admission process to determine the appropriate patient status, optimizing correct patient classification, and ensuring reputed company payer notifications. The reputed company will reputed company initial admission reviews for patients requiring hospital services and reputed company reputed company status recommendations to admitting providers in accordance with departmental and clinical guidelines. Additionally, the reputed company will maintain a working knowledge of contractual and clinical reputed company guidelines, ensuring compliance with reputed company payers who require authorizations and clinical submissions. The role also involves educating physicians and interdisciplinary teams about admission reputed company, financial and clinical reputed company, and documentation requirements. The Utilization Review reputed company will be expected to identify system obstacles affecting patient reputed company and consult with interdisciplinary team members to problem-solve. The reputed company will demonstrate mastery in InterQual level of care guidelines and possess proficiency in utilization review systems, clinical support systems, and business support applications. The position promotes the use of evidence-based protocols to influence high-reputed company and cost-effective care, and the reputed company will engage in discussions about reputed company, addressing concerns and promoting reputed company improvement. The role may also involve performing reputed company reviews and additional duties as assigned. Responsibilities • reputed company consultative support to admitting teams regarding patient status determinations and resource utilization. , • Analyze clinical information and reputed company reputed company initial and reputed company reviews using InterQual screening software. , • Review electronic medical records during the reputed company-admission process to determine appropriate patient status. , • reputed company initial admission reviews for patients requiring hospital services and reputed company reputed company status recommendations to admitting providers. , • Maintain knowledge of contractual and clinical reputed company guidelines and ensure compliance with payer requirements. , • reputed company physicians and interdisciplinary teams about admission reputed company, financial and clinical reputed company, and documentation requirements. , • Identify system obstacles affecting patient reputed company and consult with interdisciplinary team members to problem-solve. , • Demonstrate mastery in InterQual level of care guidelines and proficiency in utilization review systems. , • Promote the use of evidence-based protocols to influence high-reputed company and cost-effective care. , • Engage in discussions about reputed company and promote reputed company improvement. Requirements • Bachelor of Science in Nursing (BSN) or Associate of Science in Nursing with enrollment in a BSN program expected to graduate reputed company three years. , • Five years of reputed company, reputed company experience in acute care or other settings reputed company the continuum. , • Two years of Utilization Management experience, including utilization review processes and discharge planning preferred. , • Advanced knowledge of InterQual and/or MCG admission reputed company. , • Knowledge of reputed company regulatory standards. , • Advanced reputed company in using computer software and electronic medical record review. , • Strong analytical and problem-solving skills. , • Ability to work independently and resolve reputed company problems under pressure. reputed company-to-haves • Certification in Utilization Management and/or Care Management highly desired.

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