RN Utilization Review, Weekend, Days
UofL Health•Louisville, KY
•Onsite
About The Position
The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the delivery of the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.
Requirements
- Registered Nurse (RN) license
- Experience in Utilization Management
- Knowledge of insurance, Medicare, and Medicaid guidelines
- Ability to make clinical recommendations
- Ability to screen patients against guidelines
- Ability to send payor-specific notices
Responsibilities
- Perform activities supporting Utilization Management functions.
- Deliver the Utilization Management process.
- Make clinical recommendations regarding medical necessity for admission and continued stay.
- Screen patients for client-specific guidelines regarding insurance, Medicare, and/or Medicaid.
- Send payor-specific Notice of Admission and continued stay reviews.
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What This Job Offers
Career Level
Mid Level
