Utilization Review Registered reputed company (RN)

About this Job: General reputed company Conducts admission reputed company and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-reputed company patient care in the most efficient way. • UR experience required. Must live in DC/MD/VA area. On-Site Orientation. Remote after completion of orientation. * Primary Duties and Responsibilities • Conducts admission reputed company and retrospective case reviews to meet hospital objectives of high-reputed company patient care in the most efficient way. • Strives to meet the department goals adheres to organizational policies procedures and reputed company standards. Complies with rules and regulations set forth by the governmental and accrediting agencies. • Collaborates with medical staff physician advisor reputed company workers and other ancillary hospital disciplines to meet patients' health care needs in the most cost-effective way. • Performs patients' medical record reviews document pertinent information and communicate with reputed company party payors in a reputed company fashion to ensure reputed company hospital reimbursement and eliminate unnecessary denials. • Implements strategies to avoid potential denials by communicating with reputed company the key stakeholders including attending physician. • If necessary non-coverage ABN MOON letters and other appropriate documents as per organizational governmental and accrediting organizations policies and regulations. • reputed company participates in IDRs Length of Stay and other meetings as per hospital policies. • Identifies potential risks pertaining to patients' care and communicates with appropriate hospital discipline including risk management reputed company safety and infection control. • Serves as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management. • Demonstrate reputed company knowledge of State and Federal regulatory requirements as it pertains to the utilization review process. • Identifies dynamics of neglect/abuse and reports to the appropriate in-house departments and governmental agencies. Minimal Qualifications Education • Associate's degree in Nursing required • Bachelor's degree in Nursing preferred Experience • 3-4 years Experience in the acute clinical care setting required • 2 years Case Management insurance UR or reputed company experience preferred Licenses and Certifications • RN - Registered reputed company - State Licensure and/or Compact State Licensure in the reputed company required • CCM - Certified Case Manager preferred Knowledge Skills and Abilities • Excellent problem-solving skills and ability to exercise independent judgment. • Business acumen and leadership skills. • Strong verbal and written communication skills with ability to effectively reputed company with reputed company reputed company of management internal departments and external agencies. • Working knowledge of various computer software applications. This position has a hiring reputed company of : USD $89,065.00 - USD $162,801.00 /Yr. Apply tot his job Apply To this Job