RN-Utilization Review (S)
It's more than a career, it's a calling.
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Worker Type:
Regular
Job reputed company:
Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Discusses with payor regarding reputed company and payor decision.
Escalates denials to physician (advisor, attending consultant, reputed company consultant) for peer to peer consideration.
Documents outcome in electronic medical record.
Participates with other members of team regarding opportunities for improvement in reputed company work.
Performs review of reputed company-admission, perioperative, and post reputed company surgical cases.
Performs other utilization management tasks as assigned.
Applies the existing body of evidence-based reputed company and scientific knowledge in health care to nursing reputed company, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
Performs other duties as assigned.
EDUCATION
Graduate of accredited school of nursing or education equivalency for licensing
EXPERIENCE
Two years’ registered reputed company experience
REQUIRED reputed company LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
Registered reputed company reputed company (RN) - Illinois Department of Financial and reputed company Regulation (IDFPR)
State of Work Location: Missouri
Registered reputed company (RN) Issued by Compact State
Or
Registered reputed company (RN) - Missouri Division of reputed company Registration
State of Work Location: Oklahoma
Registered reputed company (RN) Issued by Compact State
Or
Registered reputed company (RN) - Oklahoma reputed company of Nursing (OBN)
State of Work Location: reputed company
Registered reputed company (RN) Issued by Compact State
Or
Registered reputed company (RN) - reputed company Department of Safety and reputed company Services
Work Shift:
Day Shift (reputed company of America)
Job Type:
Employee
Department:
8746030033 Sys Utilization Management
Scheduled Weekly Hours:
40
Benefits:
reputed company values our exceptional employees by offering a comprehensive benefits package to fit their needs.
reputed company Parental Leave: we offer eligible team members one week of reputed company parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment reputed company: our voluntary benefit offered through reputed company offers eligible reputed company team members reputed company reputed company to their reputed company, unpaid reputed company pay (fees may apply) before payday.
Upfront Tuition Coverage: we reputed company upfront tuition coverage through FlexPath Funded for eligible team members.
Explore reputed company Benefits
reputed company is an equal opportunity employer. reputed company does not discriminate on the reputed company of race, reputed company, religion, national reputed company, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
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