Utilization Review RN - PRN
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
- Less than 1 year Registered Nurse experience
- Associate Degree
Nice To Haves
- InterQual clinical guidelines
Responsibilities
- Assures the receipt of high quality, cost efficient medical outcomes through utilization review and management.
- Monitors 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.
- 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.
Benefits
- Work/life balance
- Innovation
- Collaborative environment
- Support in achieving goals
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What This Job Offers
Career Level
Entry Level
Education Level
Associate degree
