Utilization Review-Case Management Registered Nurse (Full-Time)

Job Title

Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers.

*Pay Range: $50/hr. to $60/hr.

Work Schedule: Monday to Friday from 8:00 a.m. to 4:30 p.m.

Responsibilities

• Admissions: Conduct admission reviews
• Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews
• Payment Appeals: Prepare and submit appeals to third party payers
• Recordkeeping: Maintains appropriate records of the Utilization Review Department
• Training: Provide staff in-service training and education
• Maintains confidentiality of patients at all times
• Ability to cope well with stress and have a strong sense of compassion
• Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
• Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint)
• Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
• Strong written and verbal communication skills
• Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
• Ability to work independently and as part of a team
• Good judgment, problem solving and decision-making skills
• Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others
• Ability to work in a fast-paced, expanding organization

Skills

• Demonstrated knowledge of health care service delivery systems and third party reimbursement
• Two or more years' experience working in managed care environment
• Ability to apply and interpret admission and continued stay criteria
• Strong understanding of admission and discharge function
• Familiarity with medical terminology, diagnostic terms and treatment modalities
• Knowledge of medical record keeping requirements
• Ability to comprehend psychiatric evaluations, consults, and lab results