Registered Nurse; RN Utilization Review NonExempt

Registered Nurse (RN) Utilization Review Case Manager Non-Exempt

Job Type: Full time Days

Location: Remote

Position Summary: Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays.

Reports to: Director - Case Management

What We Offer

Supporting and rewarding our team is essential to the care we provide. In addition to competitive base compensation, this full-time night shift position includes:

• Medical, Dental, and Vision Coverage
• 401(k) Retirement Plan
• Generous Paid Time Off (PTO)
• PTO Cash-Out Opportunities
• PTO Donation Program
• Tuition Reimbursement (for qualifying candidates)
• Employee Assistance Program - support for mental, physical, and financial wellness
• Employee Recognition and Awards Programs

Qualifications & Requirements

• Current Registered Nurse (RN) license
• Associate's degree or RN Diploma in Nursing - Accepted with Bachelor's degree in related healthcare field:
  Bachelor's degree in Nursing or Related Healthcare Field - Required
• Three years' experience in acute care, case management or related healthcare field - Required
  Two years experience in utilization review - Required

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Essential Functions

• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Calculates the lengths of stay and continued-stay days for patients.
• Maintains a liaison with the Social Service Department to facilitate timely discharge planning.
• Processes claim denials and follow up
• Works closely with Revenue Integrity and Parallon on denied claims.
• Manages UR for observation patients.
• Non-Essential Functions
• Performs other duties as assigned

About Our Health System

Maria Parham Health is a 98-bed hospital located in Henderson, NC, and a proud member of Lifepoint Health-a leading, diversified healthcare delivery network. With hospitals and care facilities nationwide, Lifepoint is committed to making communities healthier by supporting caregivers and enhancing care quality across the country.

Whether you're just starting your career or looking for your next opportunity, Maria Parham is a place where your experience matters-from day one.

Equal Opportunity Employer

Maria Parham Health is an Equal Opportunity Employer. We are committed to a diverse and inclusive workplace and comply with all applicable laws prohibiting discrimination and harassment in employment.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment:
Minority/Female/Disabled/Protected Veteran

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people.

We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.