Utilization Review Nurse

HCA Kansas City , MO 64126

Posted 3 months ago

This is a Full Time Work-From-Home position.

Nurse Utilization Review FT Work from Home

HCA MidAmerica division consists of 13 hospitals in Missouri, Kansas, Mississippi, and Louisiana.

HCA MidAmerica is part of HCA, one of the nation's leading providers of healthcare services.

Though HCA is made up of locally managed facilities that include 177 hospitals and 119 free-standing surgery centers located in 21 states and in the United Kingdom, we are all part of one incredible story about 270,000 talented and diverse colleagues, united in a mission to care for and improve human life. We are grounded in a culture that is patient-focused and compassionate, and we are supported by an organization whose unique scale unlocks possibilities.

HCA is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious Full Time WFH Utilization Review Nurse to help us reach our goals. Unlock your potential here!

OPERATIONAL DUTIES INCLUDE BUT ARE NOT LIMITED TO:

This position will focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment, modalities, medications, services and application of treatment protocols. A team approach with the facility Case Management team is critical.

  • Perform admission InterQual as per Plan contract or within 24 hours on all Non-Medicare, non-Observation and non-Mother/Baby inpatients.

  • Document note to support Inpatient admission.

  • Review for MD inpatient order.

  • Ensure the patient's status is correct.

  • Perform continued stay InterQual as per Plan contract, a minimum of every 3 days and submit to the Plan.

  • Review concurrent denials and work with facility, physician and Plan to overturn the denial.

  • Communicate denial status to the facility and physician.

  • Follow all HCA standards regarding documentation and education.

  • Communicate with physicians regarding patient status.

  • Communicate medical necessity and responder criteria to the facility Case Manager.

  • Review the Certification / Authorization report daily to determine deficiencies.

  • Documentation to take place in Midas in the Care Enhance Review Manager Enterprise (CERME), Midas Certification Entry, Midas Concurrent Review Entry and the Avoidable Denied Days module.

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO, medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchases, program and student loan repayment. We would love to talk to you about this fantastic opportunity.

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status."

EDUCATION

  • B.S.N. Bachelor of Science in Nursing (preferred)

EXPERIENCE

  • At least one year InterQual experience required

  • Acute Care hospital experience

  • Third Party Payer experience helpful

  • Denial Management helpful

  • You must reside within 100 miles of the nearest HCA facility

CERTIFICATE/LICENSE

  • Registered Nurse (RN)
  • CCM, ACM or CPUR (or willing obtain within the first year)
icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Manager Utilization Review

HCA

Posted 3 weeks ago

VIEW JOBS 8/27/2019 12:00:00 AM 2019-11-25T00:00 RN Manager Utilization Review (Work-from-Home) HCA MidAmerica division consists of 13 hospitals in Missouri, Kansas, Mississippi, and Louisiana with approximately 2,500 beds. HCA MidAmerica is part of HCA, one of the nation's leading providers of healthcare services. Though HCA is made up of locally managed facilities that include 177 hospitals and 119 free-standing surgery centers located in 21 states and in the United Kingdom, we are all part of one incredible story about 270,000 talented and diverse colleagues, united in a mission to care for and improve human life. We are grounded in a culture that is patient-focused and compassionate, and we are supported by an organization whose unique scale unlocks possibilities. HCA is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious RN Manager Utilization Review to help us reach our goals. Unlock your potential here! This position will focus on utilization review and denials to include assessment of medical records for appropriateness, level of care provided; including assessment of utilization of treatment, modalities, medication, services and application of treatment protocols. A team approach with the facility Case Management team is critical. * Work with the Leadership team including the Division CM Director and the Denial Manager to implement and monitor key management strategies impacting functional areas within the utilization review area of responsibility. * Assist with the management of facility concerns and elevate to the Division Director of Case Management and or the Denial Manager. * Ensure the Utilization Review team is meeting the needs of the internal and external customers, the department and the Company. * Provide strategic leadership with establishing policies and procedures. * Monitor the migration to centralization and provide support to the UR team members as needed. * Develop, implement and monitor key criteria to ensure that processes are working as designed. * Work with Denial Manager in the Denial Management Action Team (DMAT) process. * Monitor reports including but not limited to Certification Authorization, Medical Necessity Overview, I-Plan Change * Schedule meetings with PC&A for Plan language changes, updates, and reporting of issues or trends. * Escalate issues with authorizations to the Plans * Monitor and trend issues with the Payers * Provide oversight for the day to day department activities including but not limited to, education, productivity monitoring, staffing support, communication and scheduling. * Follow all HCA standards regarding documentation and education. We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO, medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchases, program and student loan repayment. We would love to talk to you about this fantastic opportunity. EDUCATION * Master's in Nursing or Healthcare Administration preferred or equivalent work experience * Minimum Bachelor's in Nursing EXPERIENCE * InterQual experience required * Director of Case Management preferred or UR manager experience * Acute Care Hospital experience minimum 4-5 years * Third Party denial experience helpful CERTIFICATE/LICENSE * Registered Nurse * CCM, ACM or CPUR strongly preferred You must live within 1 hour from an HCA facility. We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status HCA Kansas City MO

Utilization Review Nurse

HCA