RN Utilization Review

1 month ago

Southfield, United States Ascension Full time
Details
  • Department: Trauma Administration
  • Schedule: Full Time Days 40 hours/week
  • Hospital: Ascension Providence Southfield
  • Location: Southfield, MI
Benefits

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

 

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning and utilization review.

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Requirements

Licensure / Certification / Registration:

  • Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Additional Preferences

5 years minimum of clinical experience as a Registered Nurse (BSN preferred) or equivalent; trauma experience preferred. Previous experience with data abstraction from medical records, and or analyzing and interpreting processes of care, and clinical outcomes is preferred. Other required skills include excellent written and verbal communication as well as working knowledge of computer software (Microsoft and Google) and trauma registry applications.

Why Join Our Team

Ascension Michigan operates 16 hospitals and more than 300 related healthcare facilities that together employ nearly 23,000 compassionate associates. When you join our care teams, you join a team dedicated to providing spiritually centered, holistic care which sustains and improves the health of the communities we serve throughout Michigan.

 

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

 

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

 

For further information, view the  EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

 

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

 

Pay Non-Discrimination Notice

 

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

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This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

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