RN - Case Manager/Utilization Review- FT/80 $10,000 Sign on Bonus

4 weeks ago


Springfield, United States Springfield Hospital Inc. Full time
Job DescriptionJob DescriptionDescription:

The Utilization Review Registered Nurse (RN) will:

  • Assist in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers, in conjunction with the admitting/attending physician.
  • Partner with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed.
  • Conduct concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented.
  • Along with other health care team members, monitor the use of hospital resources and identifies delays.
##### $10,000 SIGN-ON BONUS FOR EXPERIENCED PROFESSIONAL#####(External candidates only)Requirements:
  • Associate degree in Nursing from an accredited school
  • Bachelor of Science in Nursing (BSN) from an accredited school of nursing (preferred)
  • Three (3) years of recent clinical or utilization management experience
  • Competence in standardized medical necessity criteria (preferred)
  • Three (3) years of recent case management or utilization management experience. (preferred)
  • Current Vermont RN licensure in good standing with no restrictions or stipulations or multistate compact licensure in good standing with no restrictions or stipulations
  • Basic Life Support (BLS) for Healthcare Providers
  • Accredited Case Manager (ACM) certification, Certified Case Manager (CCM) or Case Management Administrator Certification (CMAC) certification (preferred)
  • Ability to understand, interpret, and explain data for utilization management functions.
  • Highly developed written, verbal, and presentation skills.
  • Possesses knowledge of care delivery systems across the continuum of care, including trends and issues in care reimbursement.
  • Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management.

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