Utilization Review Nurse

Schedule: Monday to Friday (08:30 - 17:00). Pay Rate: $42/hr. POSITION OVERVIEW: High-level overview of the department: Centralized acute admission utilization review across 13 acute care and critical access hospitals What type of unit: Utilization Management Number of beds on the unit: NA Ancillary staff and charge: Utilization Management Assistant, UM Managers: Pam Long, Jennifer Liles What other units they could/will float to: NA What type of EMR is used: Cerner with Careport (Allscripts) Required Skills/Experience: Licensed RN (multistate or TX RN), 2 years acute care UM experience (or equivalent). Proficiency with InterQual/MCG and CMS regulations. Preferred Skills/Experience (if any): Use of payor portals, familiarity with managed Medicare and Medicaid insurers, Google Workspace, remote work experience Other Proficient and adaptable with multiple technologies simultaneously. ROLES AND RESPONSIBILTIES: Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance with federally mandated and third party payer utilization management rules and regulations. BENEFITS: Medical Dental Vision 401(K) EEOC Compliance: We are an equal opportunity employer, and all qualified applicants will receive consideration for employment. DISCLAIMER: AI Usage Policy: Pacer Group uses AI to assist in screening applications. Final hiring decisions are made by human recruiters based on qualifications and experience. #J-18808-Ljbffr