RN - Utilization Review
Location
United States
Posted
2 days ago
Salary
$48 - $94 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
RN - Utilization Review
Providence
Role Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. - Utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines thereby expediting the billing process, payment, and preventing governmental sanction. - Responsible for performing comprehensive admission, concurrent, and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated, and reported. - Actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. - Requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM. Qualifications - Upon hire: Washington Registered Nurse License. - 3 years of Nursing experience. Requirements - Bachelor's Degree in Nursing or Associate's Degree in Nursing (preferred). - 3 years of experience in Utilization Review, Care Management, Quality Management, and/or Discharge planning (preferred). Benefits - Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching. - Health care benefits (medical, dental, vision). - Life insurance and disability insurance. - Time off benefits (paid parental leave, vacations, holidays, health issues). - Voluntary benefits and well-being resources. - Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
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