RN - Utilization Review

RN - Utilization Review

Utilization Review Nurse*THIS IS NOT A REMOTE POSITION. It is an in person role.Shift:5x8 s; M-F; 8:30 5pmNo WeekendsNo CallEDUCATIONGraduate from an accredited school of nursing, BSN preferred.EXPERIENCEMinimum of two (2) years of Utilization Review experience. EPIC experience is requiredAcute Hospital experience is requiredMust have travel experience. SKILLS:Utilization Review experience required. Experience in Denials Management Insurance Denials, Peer-to-peer, Appeals is preferred. Experience with completing Utilization Review in the hospital setting and using InterQual and MCG evaluation criteria to justify admissions and level of care with insurance companiesLICENSURE /CERTIFICATIONNC or compact state RN licenseBLS RequiredACM/CCM Preferred Average daily census : 30Orientation: 24 hoursThis position facilitates utilization management processes to support the right care is provided at the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary; in collaboration with the care team. This position provides third-party payers clinical information to assure reimbursement; and coordinating care with the treatment team, patient, family, and others. Communicates with physicians for appropriate documentation to support authorization of services.