RN - Utilization Review - Remote
About The Position
The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams. Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual). Complies with CMS regulation regarding utilization review/management. Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact. Submits referrals for secondary level review as appropriate and follows through on process. Documents communication and work in electronic medical record. Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing. The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter. Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer. Saint Luke’s Health System includes 18 hospitals and campuses across the Kansas City region, home care and hospice, behavioral health care, dozens of physician practices, a life care senior living community, and more. Find out more about what Saint Luke’s offers: http://www.saintlukeskc.org/about-saint-lukes Are you interested in staying up to date on openings at Saint Luke’s Health System? Simply sign up for job alerts at https://careers.saintlukeskc.org/job-alerts When we have opportunities that meet your interests, you will receive an email with the job details. Saint Luke’s Health System values our employees and we encourage them to apply to any internal openings. If you are a current Saint Luke's Health System employee, please apply through your Workday account by typing "Find Jobs" in the top left corner search bar. You can also follow the link below to the current internal career site to apply. http://www.myworkday.com/saintlukes/d/task/1422$1011.htmld
Requirements
- Less than 1 year Applicable Experience
- Registered Nurse - Various
- Associate Degree
Responsibilities
- assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management
- monitoring patient charts and utilization of health care services
- Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams
- Completes initial and concurrent reviews
- identifies appropriate level of service and length of stay, using clinical guidelines (InterQual)
- Complies with CMS regulation regarding utilization review/management
- Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact
- Submits referrals for secondary level review as appropriate and follows through on process
- Documents communication and work in electronic medical record
- Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
Number of Employees
1,001-5,000 employees
