Registered Nurse Utilization Review, Case Management, Per Diem, 8A-4:30P

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare Team for optimal efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention and coordination to decrease avoidable delays denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry; Facilitates communication between payers, review agencies and healthcare team; Identify delays in treatment or inappropriate utilization and serves as a resource; Coordinates communication with physicians; Identify opportunities for expedited appeals and collaborates resolve payer issues and ensures, maintains effective communication with Revenue Cycle Departments. Estimated pay range for this position is $45.00 / hour depending on experience.

Degrees:
Associates

Licenses & Certifications:
CCMC Case Manager
CDMS Certified Disability Management Specialist
Registered Nurse
ABMCM Certified Managed Care Nurse
McKesson Certified Professional in Utilization Management
AAMCN Utilization Review Professionals
RNCB Certified Rehabilitation Registered Nurse
ANCC Nursing Case Management
ACMA ACM Certification
NBCC Certification in Continuity of Care, Advanced
NACCM Care Manager Certified

Additional Qualifications: RNs hired prior to 2/2012 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however, required to complete the BSN within 5 years of hire. 3 years of hospital clinical experience preferred. A Utilization Review or Case Management Certification required within 12 months of hire. Excellent written, interpersonal communication and negotiation skills. Strong critical thinking skills and the ability to perform clinical chart review abstract information efficiently. Strong analytical, data management and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Current working knowledge of payer and managed care reimbursement preferred. Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. Knowledgeable in local, state, and federal legislation and regulations, and ability to tolerate high volume production standards.

Minimum Required Experience:
3