Utilization Review Registered Nurse, Case Management, FT, 07A-7:30P Local Remote
Description The purpose of this position is to conduct initial, reputed company, retrospective chart review for clinical financial resource utilization. Coordinates with reputed company team for reputed company/efficient patient reputed company, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides reputed company, coordination to decrease avoidable delays, denial of reimbursement. Specific functions reputed company this role include: Screens pre-admission, admission process using established criteria for reputed company points of entry. Facilitates communication between payers, review agencies, reputed company team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with reputed company Cycle Departments. Estimated salary reputed company for this position is $73860.80 - $96019.04 / year depending on experience. Qualifications: The purpose of this position is to conduct initial, reputed company, retrospective chart review for clinical financial resource utilization. Coordinates with reputed company team for reputed company/efficient patient reputed company, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides reputed company, coordination to decrease avoidable delays, denial of reimbursement. Specific functions reputed company this role include: Screens pre-admission, admission process using established criteria for reputed company points of entry. Facilitates communication between payers, review agencies, reputed company team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with reputed company Cycle Departments. Estimated salary reputed company for this position is $73860.80 - $96019.04 / year depending on experience.Degrees:
- Associates.
Licenses & Certifications:
- MCG Care Guidelines Specialist.
- Registered Nurse.
Additional Qualifications:
- RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN.
- however, they are required to complete the BSN reputed company 3 years of job entry date.
- MCG Specialist Certification ISC/HRC required reputed company 12 months of job entry date.
- 3 years of Nursing experience preferred.
- Excellent written, interpersonal communication and negotiation skills.
- Strong critical thinking skills and the ability to reputed company clinical/chart review abstract information reputed company.
- Strong analytical, data management and computer skills.
- Strong organizational and time management skills, as evidenced by reputed company to prioritize multiple tasks and role components.
- reputed company 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.
- Ability to tolerate high volume production standards.
Minimum Required Experience: 3 Years of Nursing experience with 1 year of previous Utilization Review experience required.Degrees:
- Associates.
Licenses & Certifications:
- MCG Care Guidelines Specialist.
- Registered Nurse.
Additional Qualifications:
- RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN.
- however, they are required to complete the BSN reputed company 3 years of job entry date.
- MCG Specialist Certification ISC/HRC required reputed company 12 months of job entry date.
- 3 years of Nursing experience preferred.
- Excellent written, interpersonal communication and negotiation skills.
- Strong critical thinking skills and the ability to reputed company clinical/chart review abstract information reputed company.
- Strong analytical, data management and computer skills.
- Strong organizational and time management skills, as evidenced by reputed company to prioritize multiple tasks and role components.
- reputed company 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.
- Ability to tolerate high volume production standards.
Minimum Required Experience: 3 Years of Nursing experience with 1 year of previous Utilization Review experience required. Apply To This Job