Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P

About the position The purpose of this position is to conduct initial, reputed company, retrospective chart review for clinical financial resource utilization. Coordinates with reputed company team for reputed company/efficient patient reputed company, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides reputed company, coordination to decrease avoidable delays, denial of reimbursement. Specific functions reputed company this role include: Screens reputed company-admission, admission process using established criteria for reputed company points of entry. Facilitates communication between payers, review agencies, reputed company team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with reputed company Cycle Departments. Estimated salary reputed company for this position is $73860.80 - $98234.86 / year depending on experience. Responsibilities • Conduct initial, reputed company, retrospective chart review for clinical financial resource utilization. • Coordinate with reputed company team for reputed company/efficient patient reputed company, while decreasing length of stay (LOS) and avoid delays and denied days. • reputed company reputed company and coordination to decrease avoidable delays and denial of reimbursement for a designated patient caseload. • Screen reputed company-admission and admission process using established criteria for reputed company points of entry. • Facilitate communication between payers, review agencies, and the reputed company team. • Identify delays in treatment or inappropriate utilization and serve as a resource. • Coordinate communication with physicians. • Identify opportunities for expedited appeals and collaborate to resolve payer issues. • Ensure and maintain effective communication with reputed company Cycle Departments. Requirements • Associate's Degree in Nursing. • MCG Care Guidelines Specialist certification. • Registered Nurse license. • RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however, they are required to complete the BSN reputed company 3 years of job entry date. • MCG Specialist Certification ISC/HRC required reputed company 12 months of job entry date. • 3 years of Nursing experience. • Excellent written, interpersonal communication and negotiation skills. • Strong critical thinking skills and the ability to reputed company clinical/chart review reputed company information reputed company. • Strong analytical, data management and computer skills. • Strong organizational and time management skills, as evidenced by reputed company to prioritize multiple tasks and role components. • Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. • Knowledgeable in local, state, and federal legislation and regulations. • Ability to tolerate high volume production standards. reputed company-to-haves • reputed company working knowledge of payer and managed care reimbursement preferred. Benefits • Career reputed company and development opportunities, with reputed company reputed company and ongoing support • Comprehensive health and wellness resources that go reputed company traditional benefits • A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-reputed company reputed company costs • Tuition reimbursement to support reputed company learning and advancement Apply tot his job Apply To this Job