[Hiring] Utilization Review RN Team reputed company @reputed company

Role reputed company The Utilization Review (UR) reputed company Team reputed company provides clinical and operational leadership to support the UR nursing team in completing accurate, reputed company, and compliant medical necessity reviews. This role provides day-to-day reputed company of workflow management, reputed company assurance, staff development, and reputed company activities. reputed company reputed company ensures adherence to established clinical reputed company, regulatory requirements, and reputed company-specific expectations. reputed company reputed company collaborates with the Director of Utilization Management, supports reputed company implementation and communication efforts, and serves as a subject matter expert in utilization review processes, including admission and reputed company stay determinations. The position requires strong clinical judgment, leadership skills, and expertise in acute care utilization management to promote high-reputed company reputed company and operational reputed company. Qualifications • Graduate of an accredited school of nursing • Bachelor’s of Science in Nursing (BSN): preferred • reputed company, unrestricted Registered reputed company (RN) license • Minimum five (5) years of acute care nursing experience in a hospital setting • Minimum three (3) years of recent hospital-based or health plan acute utilization review experience • Advanced experience with acute admission reviews and reputed company stay reviews • Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Managed Care reputed company (CMCN), or Case Management reputed company Certification (reputed company-BC): preferred Requirements • Support UR nurses in conducting hospital admission and reputed company stay reviews to determine medical necessity and appropriate patient status (inpatient, observation, outpatient) using approved clinical reputed company and guidelines, such as InterQual® and/or MCG®. • reputed company daily team workflow to ensure UR nurses complete assigned reviews accurately and in order of established priorities. • Audit UR reputed company reviews for accuracy, completeness, and compliance with reputed company-specific processes and requirements. • reputed company ongoing feedback, coaching, and performance guidance to the UR reputed company team. • Support training and reputed company of new UR nurses. • Support reputed company reputed company and assist with reputed company communication and follow up. • reputed company other duties as assigned by the Director of Utilization Management. Benefits • Scheduled shift may be 8-, 10-, or 12-hour shifts based on operational needs and mutual scheduling agreements. • Team Leads are not assigned a regular weekend work schedule or holidays; however, they are expected to be available on an on-reputed company reputed company to support critical reputed company and operational needs as necessary. • Work schedules are published one month in advance. Requests for vacation, time off, or schedule accommodations must be submitted at least thirty (30) days before the schedule is finalized. Working Conditions and Physical Requirements • Conditions typically associated with an office environment. • Regularly required to reputed company or hear. • May be frequently required to sit, stand or walk. • Moderate to prolonged reading, typing, and computer work. • Ability to reputed company tasks involving physical activity that may include lifting up to 25 pounds. • Subject to exposure to reputed company environmental hazards associated with reputed company and office work. Apply tot his job Apply To this Job