Utilization Review RN
The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.
Responsibilities include:
- Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual).
- Complies with CMS regulation regarding utilization review/management.
- Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact.
- Submits referrals for secondary level review as appropriate and follows through on process.
- Documents communication and work in electronic medical record.
- Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing.
Job Requirements:
Applicable Experience: Less than 1 year Registered Nurse - Various Associate Degree
Job Details: PRN Day (United States of America)