RN, Utilization Review - PRN

Saint Luke's Physician Group • Kansas City, MO

4d • 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.

Requirements

• MO/KS RN license required
• Min of 2 years bedside experience preferred
• Less than 1 year Applicable Experience
• Registered Nurse
• Associate Degree

Nice To Haves

• Case Management experience preferred

Responsibilities

• Monitoring patient charts and utilization of health care services.
• Collaborating and communicating with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.
• Completing initial and concurrent reviews.
• Identifying appropriate level of service and length of stay, using clinical guidelines (InterQual).
• Complying with CMS regulation regarding utilization review/management.
• Obtaining and managing insurance authorizations.
• Proactively working denials to help mitigate financial impact.
• Submitting referrals for secondary level review as appropriate and following through on process.
• Documenting communication and work in electronic medical record.
• Working with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing.

Benefits

• We believe in work/life balance.
• We are dedicated to innovation and always looking for ways to improve.
• We believe in creating a collaborative environment where all voices are heard.
• We are here for you and will support you in achieving your goals.

What This Job Offers

• Career Level: Entry Level
• Education Level: Associate degree