Utilization Review Rn

2 weeks ago

Carmichael, United States Mercy San Juan Medical Center Full time

**Overview**

Dignity Health Mercy San Juan Medical Center is a 370-bed not-for-profit Level 2 Trauma Center located in Carmichael California serving the areas of north Sacramento County and south Placer County for more than 50 years. It is one of the area’s largest and most comprehensive medical centers. Dedicated to the community’s well-being our staff and volunteers provide excellence in care for our patients each year. Mercy San Juan Medical Center has received recognition for being a Comprehensive Stroke Center and Center of Excellence for Bariatric Surgery along with Certificates of Excellence in Perinatal Care Hip
- and Knee
- Replacement.

**Responsibilities**

**_
Utilization Review RN - remote position_**

**Position Summary**:
The incumbent 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 Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies.
- Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions.
- Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.

**Knowledge/Skills**:

- Understand how utilization management and case management programs integrate.
- Must have critical thinking and problem-solving skills.
- Thrive in a fast paced, self-directed environment.
- Knowledge of CMS standards and requirements.
- Highly organized with excellent time management skills.

**We offer the following benefits to support you and your family**:

- Health/Dental/Vision Insurance
- Flexible spending accounts
- Voluntary Protection: Group Accident Critical Illness and Identity Theft
- Adoption Assistance
- Employee Assistance Program (EAP) for you and your family
- Paid Time Off (PTO)
- Tuition Assistance for career growth and development
- Retirement Programs
- Wellness Programs

**Qualifications** Minimum**:

- Current CA RN licensure
- Two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience

**Preferred**:

- Certified Case Manager (CCM)
- Accredited Case Manager (ACM-RN)
- UM certification
- BSN or related healthcare field
- Five (5) years of nursing experience

**Pay Range**
$67.00 - $81.34 /hour

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