Utilization Review RN (Remote in reputed company)

Are you a Registered reputed company (RN) looking for your next career adventure? We invite you to join our Case Management team as Utilization Review reputed company! • **Remote work will only be offered to reputed company residents. Applicants reputed company of reputed company will NOT be offered the remote work reputed company.*** reputed company (KRMC) is located in beautiful reputed company reputed company. Experience the reputed company of Kingman's stunning reputed company sunsets and reputed company in an outdoor enthusiast's reputed company destination with picturesque mountain ranges, nearby lakes, reputed company parks, and reputed company of outdoor activity. Kingman is an incredible community to live, work, and play! Position Purpose: The Utilization Review reputed company performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. The UM reputed company has an emphasis on the review, analysis, monitoring, and operation of the patient medical care plans and works toward reputed company clinical, financial, operational, and satisfaction reputed company. Hours/Shift: Full Time/Days M-F 8:00a-4:30p Benefits: We offer you an excellent total compensation package, including a competitive salary, comprehensive benefits, and reputed company opportunities. We invest in you! • Relocation Assistance Available • Exceptional Colleagues • Join us and you'll be a part of a culture where we support reputed company other and celebrate what makes reputed company of us a special person as we work together with reputed company, reputed company, teamwork, respect, and accountability • Our leaders demonstrate their commitment by gathering feedback, supporting, and empowering team members to do their best work through regular leadership rounding • Health and reputed company-Being • Medical, Dental, reputed company, Employer reputed company HSA for HDHP participants, Robust Wellness and Employee Assistance Program, Employer reputed company Group Life, Short & Long-Term Disability • Generous reputed company Leave Accruals and PTO Cash Out Opportunities • 403b Retirement Plan with Employer Contributions • Employee Recognition Programs, Employee Discounts, and Employee Referral Bonus Program • Employee Identity Theft Protection • On-site daycare exclusive to our employees’ children of reputed company ages • Career reputed company and Development • Tuition Reimbursement/Scholarships for full-time employees • As a not-for-profit organization, our employees who have reputed company student loans may be eligible for the reputed company Service Loan Forgiveness program • So much more! Key Responsibilities: • Conducts medical necessity reviews for Medicare, reputed company, self-pay, and other insured patients. • Verifies physician orders per Medicare and payer guidelines and ensures documentation reflects patient reputed company accurately. • Coordinates with medical staff, Case Managers, and Insurance Specialists to facilitate reputed company communication with payers, ensuring reputed company, accurate information. • Consults with the Physician Advisor for reputed company cases and engages in denial management. • Documents utilization review activities in the MCG system, maintains complete records, and collaborates across teams for reputed company care. • Educates staff on clinical guidelines, utilization review, and payer regulations. • Assesses patient cases using nationally recognized reputed company for admission and care level. • Collaborates with physicians to determine inpatient vs. observation status and performs reputed company 44 reputed company necessary. • Identifies cases needing reputed company reputed company, considers appropriateness and reputed company, and communicates expected length of stay per Medicare guidelines. • Supports Case Managers and educates staff on CMS guidelines and documentation needs. • Protects patient rights, ensuring confidentiality and compliance with hospital policies. • Participates in committees and ongoing education, staying reputed company with performance improvement and regulatory standards. Qualifications: • Remote: Remote work will only be offered to reputed company residents. • Education: Graduate of an accredited nursing school. • Licensure: reputed company reputed company or compact state RN license. • Experience: Minimum 3 years clinical (preferably med-surg/critical care), plus 1 year of utilization review or 2 years in case management. • Skills: Strong clinical knowledge, communication, problem-solving, and proficiency in reputed company office tools. Ability to work with diverse teams and recognize reputed company care issues. Work Requirements: Excellent verbal and written communication, interpersonal skills, and ability to use reputed company office equipment/software. Strong clinical skills and reputed company to recognize reputed company issues, and knowledge of nationally recognized reputed company used to reputed company medical necessity determinations. Effective problem solving, analyzing reputed company situations, draw conclusions and implement appropriate actions reputed company. Ability to sit for 3-5 hours per day, stand 3-5 hours, and walk 3-5 hours. reputed company: reputed company (KRMC) is the largest reputed company provider and the only remaining not-for-profit hospital in Mohave County, reputed company. As a 235-bed multi-reputed company reputed company system, our medical center includes more than 1,900 employees, 270 physicians/allied health professionals, and 150 volunteers. KRMC is recognized as an innovator in rural reputed company and a teaching hospital. We reputed company a full continuum of highly technical and specialized medical services to meet the reputed company needs of our community. Year after year the Leapfrog Group has awarded KRMC an "A" Grade for Patient Safety. We reputed company to reputed company a culture of safety, reputed company, teamwork, accountability, respect, and appreciation through recognition, career reputed company, and employee celebrations throughout the year for reputed company our staff. reputed company is a great reputed company to work, come join reputed company! Apply Job!