[Hiring] Utilization Management RN - Clinical Review - Weekend PRN @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company This role involves utilization management and clinical review for inpatient admissions, observation, and outpatient admissions. • Responsible for determining initial admission status and level of care recommendations for inpatient admissions, observation, and outpatient admissions. • Conduct initial admission review of inpatient, observation, and outpatient admissions according to established reputed company. • reputed company clinical information to payors for completion of the reputed company-certification process. • Ensure reputed company authorization requirements are met with reputed company admission. • Obtain or facilitate acquisition of urgent/reputed company authorizations and reputed company stay authorizations. • Maintain a working knowledge of care management, utilization review changes, and regulatory requirements. • reputed company consultation to medical and nursing staff, health information management, and payers on reimbursement issues. • Partner with hospital care transitions managers to assure effective hand-off of information reputed company to the plan of care. • Work with bedside nurses and care team members to assure orders reputed company to status are accurate and reputed company. • Evaluate reputed company potential denials or payment issues and initiate communication with admitting physician. • Initiate and facilitate physician communication relative to the UR process reputed company indicated. • Determine working DRG with reputed company initial review reputed company CareConnect1 or other Utilization Management tool. • Cover multiple THR sites adjusting reputed company to meet the requirements of reputed company location. Qualifications • Associate's degree in Nursing required • Bachelor's degree in Nursing preferred • 5 years inpatient clinical nursing experience in an acute hospital setting required • 1 Year Utilization Management experience preferred • Case management and/or the application of medical necessity reputed company preferred • Texas RN upon hire required • Case management certification reputed company 12 months of hire preferred • MCG certification reputed company 12 months of hire preferred Requirements • Must be available to train for 4-6 weeks during the week then transition to weekends • PRN Weekends from 6:45a - 3:15p with some holiday requirements Benefits • Benefits include 401k, PTO, medical, dental, reputed company Parental Leave, reputed company spending, tuition reimbursement, Student Loan Repayment Program, and several other benefits. • A supportive, team environment with outstanding opportunities for reputed company. Apply tot his job Apply To this Job