Utilization Review RN (1796)

Trinity Health Systems Inc•Minot, ND

42d•$38 - $59•Onsite

About The Position

The UR RN Case Manager facilitates effective utilization of appropriate health services via collaboration with physicians, nurses, social workers, other healthcare team members (ie - financial counselors), and payers to coordinate health care services that optimize clinical outcomes and patient satisfaction with services from pre-admission through post-discharge transition for this select patient population for all portals of entry. This position performs pre-admission, concurrent admission, and retrospective clinical review of medical necessity to determine the appropriate level of care and resource utilization. The UR RN Case Manager is responsible for ensuring implementation and monitoring of compliant documentation strategies by ensuring procedure(s) noted in the pre-admission review was/were completed and the physician's orders are present, accurate, and signed before patient being discharged; or updated as needed once the operative note has been reviewed.

Requirements

Current or temporary RN license in ND or compact RN licensure.
BLS certification is required within the orientation period.
Must have three (3) years of recent experience in a clinical area.
Demonstrated evidence of dependability, diplomacy, and initiative.
Demonstrated strong communication and interpersonal skills with all levels of internal and external customers, including but not limited to medical staff, patients and families, clinical personnel, other Case Managers, support and technical staff, outside agencies, third party payers, and members of the community
Basic understanding of reimbursement issues, denials, and DRGs
Knowledge of clinical criteria for medical necessity
Personal computer skills using e-mail and Microsoft Office Suite.