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Employment Opportunities

Utilization Review Registered Nurse (RN)

Description

Essential Responsibilities:

  • Conduct admissions concurrent with retrospective utilization reviews for patients by screening inpatient and observation admissions to determine if they meet criteria for hospitalization.
  • Stay current on changes in screening criteria.
  • Assist the Utilization Review Coordinator in researching/preparing correspondence (insurance appeal letters, insurance denial of payment for stay letters).
  • Maintain effective, appropriate and professional communication with hospital staff, care providers, peer review, commercial insurance review entities, and third-party payors to assure maximum reimbursement.
  • Screen and assess patients for discharge planning based on age-related needs and make appropriate referrals to community agencies/hospital departments to assure continuity of care.
  • Assist with hospital’s Swing Bed Program to identify and assure proper placement of candidates; inform physicians of possible placements in Swing Bed Program.
  • Communicate with admitting/attending physicians regarding documentation and precertification requirements; maintain record of patient while hospitalized and work with physician to ensure optimal discharge planning.
  • Comply with best practices in nursing and established hospital policies/procedures to render care of patients.
  • Serve as Charge Nurse, as assigned.

Minimum Qualifications

•    Licensed Registered Nurse in the State of Michigan required.

•    Minimum of 2 years previous RN nursing experience required.

•    Basic Cardiac Life Support (BCLS) certification or ability to obtain within 1 month of hire.

•    Experience in Utilization Review and knowledge of DRG reimbursement system preferred.

•    Ability to manage a diverse workload and prioritize tasks; assume management responsibilities as needed.

•    Ability to physically and mentally carry out the functions of this position.

•    Exceptional customer service skills with a professional demeanor that ensures trust, competence and compassion amongst patients, providers and team members.

•    Ability to successfully pass a pre-hire drug screening and background check.

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