2212, UTIL MGMT REVIEW NURSE - ADMIN RN

Memorial Health • Springfield, MA

80d • $32 - $52

About The Position

Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services. This is not a remote position.

Requirements

• Associates Degree in Nursing; Bachelor’s Degree in Nursing preferred.
• Current RN licensure in the State of Illinois required.
• Minimum of 3-5 years of recent acute care and/or home health nursing or case management experience required.
• Previous utilization review experience strongly preferred.

Nice To Haves

• Understanding of healthcare reimbursement mechanisms preferred.
• Strong oral and written communication skills.
• Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes.
• Understanding of the principles of performance improvement, team collaboration, and conflict resolution.

Responsibilities

• Perform clinical review of patient records to evaluate the utilization of acute care services.
• Communicate to third party payors to support the medical necessity of hospital admissions for reimbursement.
• Ensure the patient care team is aware of general length of stay requirements for all patients.
• Facilitate physician documentation through concurrent interaction with physicians.
• Provide clinical knowledge and data collection for quality improvement initiatives.
• Optimize reimbursement for acute care services.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees