Description
Who We Are :
The Care Coordination Department at the Elliot Hospital takes great pride in serving their community, patients, and families.
Our Utilization RN’s observe best practices and strive to attain the best outcomes possible for their patients. If you are a nurse with strong clinical experience / skills, please consider our department! We will do on the job training for experienced Nurses who meet the requirements below! Apply today!
About the Job :
The Utilization Review RNs (UR RN) primary responsibility is to monitor adherence to the hospital’s utilization review plan to ensure the effective and efficient use of hospital services.
The Utilization Review RN will utilize medical necessity screening tools, such as InterQual, to complete admission reviews in determining appropriate level of care;
and will document continued stay reviews for continued need for inpatient care, appropriateness of tests and procedures, and an estimation of the patient's expected length of stay. And more.
What You’ll Do :
- Screens all patients admitted to Elliot Hospital either on admission or next business day to determine the appropriate level of care
- Identifies and monitors observation status patients concurrently to ensure appropriate utilization of observation status
- Performs concurrent reviews for patients to ensure that extended stays are medically justified
- Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued stay
- Obtains timely insurance authorization / certifications from all payers requiring authorization of hospitalizations, test, procedures, medications, etc
- Maintains knowledge of current Federal, State and payer regulatory requirements pertinent to utilization review processes
Who You Are :
- Bachelor's degree in a healthcare-related field or equivalent experience Current BSN or commitment to achieving the degree in a specified amount of time
- A minimum of three (3) years hospital case management or utilization management experience , Required.
- CCM or ACM preferred
- Excellent clinical documentation, and successful usage of EMR systems, Preferred
Why You’ll Love Us :
- Health, dental, prescription, and vision coverage for full-time & part-time employees
- Short term, long term disability, Accident insurance, & life insurance
- Tuition Reimbursement
- Referral bonuses
- Accrued earned time for full-time & part-time employees
- 403b Retirement plans, with generous employer contributions
- And more!
Work Shift : First - Days
First - Days
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