RN, Utilization Review - Full Time
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
- Kansas and Missouri Nursing License
- Associate's degree
- 1 year Registered Nurse (MO) - National Council of State Boards of Nursing (NURSYS)
- Associate Degree
Nice To Haves
- Case Management or Utilization Review experience
- Strong medical surgical background
- BSN
Responsibilities
- Monitor patient charts and utilization of health care services.
- Collaborate and communicate with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.
- Complete initial and concurrent reviews.
- Identify appropriate level of service and length of stay, using clinical guidelines (InterQual).
- Comply with CMS regulation regarding utilization review/management.
- Obtain and manage insurance authorizations.
- Proactively work denials to help mitigate financial impact.
- Submit referrals for secondary level review as appropriate and follow through on process.
- Document communication and work in electronic medical record.
- Work 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
Mid Level
Education Level
Associate degree
