RN - Utilization Review

RN - Utilization Review

Shift: 5x8 hour days

Shift 08:30 AM - 17:00 PM

Years of Experience: 2 preferred

Unit accepts first time travelers

The Case Manager is responsible for medical necessity review, discharge planning, and utilization review. Identifies and communicates changes in the patients plan of care to the health care team. Maintains detailed knowledge of community resources and process for referrals Using LOS anticipates patient needs, stewardship of resources and timely transitioning of patients to alternative level of care Documents in patient record in a consistent and timely manner to include initial screenings and discharge plan.

100-mile radius rule, no local candidates

Account Manager: Rachel Holliday

Email: View email address on click.appcast.io

Job Requirements & Qualifications

Previous Charge Experience: Preferred

Years of Experience: 2

Patient Ratio Experience: Required

Charting System Experience: Required

Charting System Name: Epic

Community Hospital Experience: Preferred

LTAC Experience: Not Required

Trauma Level I Experience: Not Required

Trauma Level II Experience: Not Required

Travel Experience Required: Not Required

Certifications: BLS

Skills: Acute Hospital, Admission Criteria, Appeals and Denials, Audits, Benefits Eligibility, Care coordination, CMS: Centers for Medicare and Medicaid Services, Concurrent Review, Continued Stay Reviews, Determine Medical Necessity per Evidence-Based Guidelines, Discharge Planning, DRG (Diagnosis Related Groups), HIPAA guidelines (Health Insurance Portability and Accountability Act), ICU, Medical Necessity, MS, Needs Assessment/ Order DME, Plan of Care

Facility & Patient Care Details

Patient Age Groups: Adults, Pediatrics, Geriatrics

Special Procedures/Unit Details: Not Specified

Special Equipment: Not Specified

Travel Compliance

Ardent Submission Rules: 100-mile radius rule, no local candidates

State or Compact license must be in hand at time of submittal

All RTO must be listed at time of submittal

Previous Staff must wait 1 year before returning as a traveler

Compliance Rules

Onboarding: Must complete core items/labs within 48 hours of contract signing

Modules: Modules are non-billable, all hours are factored in

NBO RN average 4-6 hours

Allied 2-3 hours

Modules are completed onsite during orientation

Guaranteed Hours: Contract Weeks: 91

Client Details

Address: 777 Hospital Way

City: Pocatello

State ID: ID

Zip Code: 83201