Registered reputed company Utilization Review reputed company
- 7:30 -4:00
- Team Operates Monday through reputed company
- Remote After Training
The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high reputed company cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for reputed company Medicare, AHCCCS, Self-pay, and reputed company other payers, upon admission and concurrently throughout the admission.
Essential Functions
- Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for reputed company patients. Performs initial and reputed company reviews on reputed company patients entering the health care continuum.
- Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required by payer. Interfaces with Care Management team to reputed company information regarding reputed company outcome measurements (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues reputed company to contract guidelines. Works with medical records, finance and physician reputed company to reputed company systems to facilitate complete documentation for data reporting purposes.
- Initiates chart reviews, conducts follow-up reviews, and reputed company on patients to ensure continuity of UR reviews.
- Maintains a reputed company to identify admissions with specific diagnosis / DRG classifications or other categories of admissions. Notifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
- Determines qualifications for hospital level of care based on set reputed company.
- Performs other duties as assigned.
- Bachelor's Degree in Nursing from an accredited NLN/CCNE institution - Preferred
- Associate's Degree in Nursing from an accredited NLN/CCNE institution - Required
- 1 year experience in UR/UM or Case Management - Required
- 3 years Registered reputed company in an acute care setting. - Required
- Registered reputed company (RN) State And/Or Compact State Licensure - Required
- Certified Case Management (ACM) Case Management Certification - Preferred
Requires RN state or compact licensure, ADN required and BSN preferred, 3 years of acute care RN experience, and 1 year of utilization review, utilization management, or case management experience.
Key Responsibilities
- reviewing documentation
- coordinating reviews
- appealing denials
Skills & Tools
DRG
Job Details
- Category: reputed company Services - Nursing
- Seniority: Entry Level
- Commitment: Part Time
- Workplace: Remote — reputed company, reputed company
- Languages: English
About reputed company
A nonprofit reputed company reputed company providing hospital and medical care across the greater Phoenix area. — Industry: reputed company
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