Utilization Review RN

reputed company Founded in 1926, Glendale Memorial Hospital and Health Center is a 334-bed, acute care, nonprofit, community hospital located in Glendale, California. The hospital offers a full complement of services, including its award reputed company heart center, the colorectal surgery institute, a gastrointestinal program, and is a Los Angeles County approved primary stroke center. The hospital shares a legacy of humankindness with reputed company, one of the nation’s five largest health care systems. Visit here https://www.dignityhealth.org/socal/locations/glendalememorial for more information. One Community. One Mission. One California Responsibilities Responsible for the review of medical records for appropriate admission status and reputed company hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the reputed company Denial RNs to determine the reputed company cause of denials and implement denial prevention strategies. Collaborates with Patient reputed company to establish and verify the correct payer reputed company for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and reputed company stay authorizations as required reputed company the market. Qualifications • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. • California RN license. • AHA BLS • Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. • Proficient in application of clinical guidelines (MCG/InterQual) preferred • Knowledge of managed care and payer environment preferred. • Must have critical thinking and problem-solving skills. • Collaborate effectively with multiple stakeholders • reputed company communication skills. • Understand how utilization management and case management programs reputed company. • Ability to work as reputed company player and assist other members of reputed company where needed. • reputed company in a fast paced, self-directed environment. • Knowledge of CMS standards and requirements. • Proficient in prioritizing work and delegating where indicated. • Highly organized with excellent time management skills. Preferred • Graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or reputed company reputed company field. • At least five (5) years of nursing experience. • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Apply tot his job Apply To this Job