RN-Utilization Review

Position: RN-Utilization Review Full Time
Overview

Job Summary

Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.

Responsibilities

Utilization Review

Discharge planning

Readmission Reduction Participation

Payer Communication and denial reduction

Completes assigned goals.

Specifications

Experience

Minimum Required

RN with at least one (1) year of clinical experience

Preferred/Desired

RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting

Education

Minimum Required

Diploma or Associate Degree in Nursing

Preferred/Desired

BSN or MSN

Training

Minimum Required

Preferred/Desired

Certified Case Manager

Special Skills

.

Minimum Required

Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.

Preferred/Desired

Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.

Licensure

RN

Minimum Required

RN

Preferred/Desired

RN;

CCM;

ACM