RN UTILIZATION REVIEW COORDINATOR

3 weeks ago

AZ United States Maricopa Integrated Health System Full time
As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status and medical necessity for services provided through the acute care medical hospital. This requires proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system. The RN Utilization Review Coordinator is responsible for assuring the appropriate use of resources and facilitating the patient#s progression through the continuum of care in a timely and cost-effective manner. This position works with managed care plans, third-party payers, the business office, and the interdisciplinary team to ensure authorization for reimbursement at the appropriate level is confirmed to ensure payment of expected reimbursement. # Hourly Pay Range: $34.15 - $50.37 # Qualifications Education: Prefer a bachelor#s degree in Nursing. Experience: Preferred to have at least three (3) years of recent acute clinical RN hospital experience, preferably in Case Management and/or Utilization Management.# Specialized Training: Trained in Epic, InterQual, Midas and internally used software programs is strongly preferred. Certification/Licensure: Must possess a current, valid Arizona RN licensure and be in good standing with the AZ Board of Nursing. Prefer specialty certification in utilization or case management to be obtained within 30 months of hire. Prefer to have Basic Life Support within 30 days of hire. Prefer to complete CPI training within six months of hire. Knowledge, Skills, and Abilities: Must have a working knowledge of case management, hospital, community resources, and resource/utilization management. The position requires excellent communication, clinical skills, and maintaining professional rapport with physicians. Requires extensive knowledge of evidence-based clinical guidelines, best practice, workup, treatment, prognosis, and hospital procedures. Critical thinking ability is essential. Strong critical care skills, understanding of medical documentation and pathophysiology. Knowledge of acute care criteria sets and state and federal reimbursement programs. Requires the ability to read, write, and speak effectively in English.

As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status and medical necessity for services provided through the acute care medical hospital. This requires proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system. The RN Utilization Review Coordinator is responsible for assuring the appropriate use of resources and facilitating the patient's progression through the continuum of care in a timely and cost-effective manner. This position works with managed care plans, third-party payers, the business office, and the interdisciplinary team to ensure authorization for reimbursement at the appropriate level is confirmed to ensure payment of expected reimbursement.

Hourly Pay Range: $34.15 - $50.37

Qualifications

Education:

* Prefer a bachelor's degree in Nursing.

Experience:

* Preferred to have at least three (3) years of recent acute clinical RN hospital experience, preferably in Case Management and/or Utilization Management.

Specialized Training:

* Trained in Epic, InterQual, Midas and internally used software programs is strongly preferred.

Certification/Licensure:

* Must possess a current, valid Arizona RN licensure and be in good standing with the AZ Board of Nursing.
* Prefer specialty certification in utilization or case management to be obtained within 30 months of hire.
* Prefer to have Basic Life Support within 30 days of hire.
* Prefer to complete CPI training within six months of hire.

Knowledge, Skills, and Abilities:

* Must have a working knowledge of case management, hospital, community resources, and resource/utilization management.
* The position requires excellent communication, clinical skills, and maintaining professional rapport with physicians.
* Requires extensive knowledge of evidence-based clinical guidelines, best practice, workup, treatment, prognosis, and hospital procedures.
* Critical thinking ability is essential.
* Strong critical care skills, understanding of medical documentation and pathophysiology.
* Knowledge of acute care criteria sets and state and federal reimbursement programs.
* Requires the ability to read, write, and speak effectively in English.

  • RN Utilization Review Coordinator

    4 days ago

    Phoenix, AZ, United States Maricopa Integrated Health System Full time

    As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status...

  • RN Utilization Review Coordinator

    4 days ago

    Phoenix, AZ, United States Maricopa Integrated Health System Full time

    As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status...

  • RN Utilization Review Coordinator

    3 days ago

    Phoenix, AZ, United States Maricopa Integrated Health System Full time

    As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status...

  • RN UTILIZATION REVIEW COORDINATOR

    2 weeks ago

    Phoenix, AZ 85002, USA, United States Maricopa Integrated Health System Full time

    As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status...

  • Utilization Review RN

    4 days ago

    Omaha, NE, United States Common Spirit Full time

    Overview Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the...

  • Utilization Review RN

    4 days ago

    Omaha, NE, United States Catholic Health Initiatives Full time

    **Overview** Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the...

  • UTILIZATION REVIEW RN

    2 weeks ago

    Richmond, VA, United States Virginia Commonwealth University Health System Full time

    The Utilization Review RN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review.This position functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers. The Utilization Review RN performs reviews of current inpatient services,...

  • Utilization Review RN

    4 days ago

    Richmond, VA, United States Virginia Commonwealth University Health System Full time

    The Utilization Review RN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. This position functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers. The Utilization Review RN performs reviews of current inpatient...

  • RN UTILIZATION REVIEW

    3 weeks ago

    , NC, United States Cone Health Full time

    OverviewPerforms admission and continued stay utilization reviews and discharge screening to assure the medical necessity of hospital admission, appropriate level of care, continued stay and supportive services, and to examine delays in the provision of services. Coordinates care transitions from inpatient to the next level of care. Collaborates with...

  • UTILIZATION REVIEW RN PRN

    3 weeks ago

    , VA, United States Virginia Commonwealth University Health System Full time

    The Utilization Review RN PRN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review.This job functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers, performs reviews of current inpatient services, and determines medical...

  • UTILIZATION REVIEW RN PRN

    3 weeks ago

    , VA, United States VCU Health Full time

    The Utilization Review RN PRN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. This job functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers, performs reviews of current inpatient services, and determines medical...

  • RN Utilization Review

    4 days ago

    Greensboro, NC, United States Cone Health Full time

    Overview Performs admission and continued stay utilization reviews and discharge screening to assure the medical necessity of hospital admission, appropriate level of care, continued stay and supportive services, and to examine delays in the provision of services. Coordinates care transitions from inpatient to the next level of care. Collaborates with...

  • Utilization Review RN PRN

    5 days ago

    Richmond, VA, United States Virginia Commonwealth University Health System Full time

    The Utilization Review RN PRN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. This job functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers, performs reviews of current inpatient services, and determines medical...

  • Utilization Review RN- Onsite

    3 weeks ago

    Plattsburgh, NY, United States The University of Vermont Health Network Full time

    Please Note: This is an onsite position supporting the Emergency Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and evaluates variances of resource utilization, complications and overall quality of care based on benchmarked criteria or established...

  • Utilization Review RN- Onsite

    4 weeks ago

    Plattsburgh, NY, United States The University of Vermont Health Network Full time

    Please Note: This is an onsite position supporting the Emergency Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and evaluates variances of resource utilization, complications and overall quality of care based on benchmarked criteria or established...

  • RN - Utilization Review

    2 days ago

    Medford, OR, United States Health Advocates Network Full time

    Health Advocates Network is urgently hiring Utilization Review Registered Nurses (RNs) in the Medford, OR area. Must have 2 years of Discharge Planning and Utilization Review experience. + Pay Rate: $2,760 weekly + Specialty: Utilization Review Registered Nurse (RN) + Shift Info: Day + 13 Week Contracts and more available! RN Qualification and...

  • UTILIZATION REVIEW RN

    3 weeks ago

    , CA, United States Marshall Medical Center Full time

    Department:Utilization ReviewShift:Primarily Days (United States of America)Employee Type:RegularPer Diem Type (if applicable):Minimum Pay Range:$55.77 - $69.71Job Description:POSITION SUMMARYThe Utilization Review Nurse (UR RN) uses a collaborative process, which provides professional accountability for the utilization of the health care resources to the...

  • UTILIZATION REVIEW NURSE

    2 days ago

    Randallstown, MD, United States LifeBridge Health Full time

    UTILIZATION REVIEW NURSE (RN)Randallstown, MDNORTHWEST HOSPITALNW CARE MANAGEMENTFull-time - Day shift - 8:00am-4:30pmRN Other81988Posted:March 21, 2024Apply NowSave JobSavedSummaryPosition Summary:Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to...

  • Utilization Review RN

    4 days ago

    Placerville, CA, United States Marshall Medical Center Full time

    Department: Utilization Review Shift: Primarily Days (United States of America) Employee Type: Regular Per Diem Type (if applicable): Minimum Pay Range: $55.77 - $69.71 Job Description: POSITION SUMMARY The Utilization Review Nurse (UR RN) uses a collaborative process, which provides professional accountability for the utilization of the health...

  • UTILIZATION REVIEW NURSE

    3 weeks ago

    , VT, United States Central Vermont Medical Center Full time

    Building Name: HHH - In-State Hybrid/RemoteRegularDepartment: CVMC - Care ManagementFull TimeStandard Hours: 40Biweekly Scheduled Hours:Shift: DayPrimary Shift: 7:30 AM - 4:00 AMWeekend Needs: NoneRecruiter: Kate DaviesPOSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital...