Current jobs related to Registered Nurse Utilization Management - Port Huron - McLaren Health Care
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Registered Nurse Utilization Management
1 month ago
Port Huron, United States McLaren Health Care Part timeDepartment:RN Utilization Management*Scheduled Bi-Weekly Hours:40*Daily Work Times:8a-4:30pResponsible for determining the appropriate patient status based on the regulatory and reimbursement requirements of various commercial and government payers in collaboration with the admitting/attending physician. Partners with the health care team to ensure hospital...
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Port Huron, Michigan, United States McLaren Health Care Full timePosition Overview:The Clinical Nurse Specialist in Utilization Management plays a crucial role in assessing patient status in accordance with the regulatory and reimbursement guidelines set forth by various payers. This position collaborates closely with physicians and the healthcare team to ensure that hospital admissions are justified based on medical...
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Registered Nurse
4 months ago
Port Huron, United States McLaren Port Huron Full timePosition Summary : The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by...
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Registered Nurse
6 months ago
Port Huron, United States McLaren Port Huron Full timePosition Summary : The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by...
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Nurse Practitioner
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Registered Nurse
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Hospice Registered Nurse RN Case Manager
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Registered Nurse
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Registered Nurse
5 days ago
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Registered Nurse
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Port Huron, United States Prime Healthcare Full timeOverview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians....
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Registered Nurse
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Traveling Registered Nurse
2 weeks ago
Port Huron, Michigan, United States Cynet Health Full timeJob Title: RN Emergency RoomJob Specialty: Emergency Room NursingJob Duration: 13 weeksShift: 07:00 PM - 07:00 AMGuaranteed Hours: Not specifiedExperience: Minimum of 2 years requiredLicense: Registered Nurse (RN)Certifications: BLS, PALS, ACLS, NRP, CPIJob Requirements:* Provide critical care and treatment to patients in an emergency room setting.*...
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Registered Nurse Casual
5 months ago
Port Huron, United States McLaren Port Huron Full timePosition Summary : The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by...
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Registered Nurse, Emergency Department
4 weeks ago
Port Huron, United States McLaren Port Huron Full time*$15,000 SIGN ON BONUS**Department: *Emergency Department*Daily Work Times: *7p-7:30a*Scheduled Bi-Weekly Hours: *72*Position Summary:*The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice....
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Registered Nurse, Emergency Department
4 weeks ago
Port Huron, United States McLaren Port Huron Full time*$15,000 SIGN ON BONUS**Department: *Emergency Department*Daily Work Times: *7p-7:30a*Scheduled Bi-Weekly Hours: *72*Position Summary:*The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice....
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Emergency Room Registered Nurse
1 month ago
Port Huron, Michigan, United States Prime Healthcare Full timePosition OverviewAt Prime Healthcare, we pride ourselves on our unwavering commitment to excellence in patient care. Our facility, a recognized leader in healthcare, is currently seeking dedicated professionals to enhance our Emergency Department.About Our FacilityPrime Healthcare operates a community hospital that offers a comprehensive array of inpatient...
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Registered Nurse, Emergency Department
4 weeks ago
Port Huron, United States McLaren Port Huron Full time $34 - $47*$15,000 SIGN ON BONUS*Please double check you have the right level of experience and qualifications by reading the full overview of this opportunity below.*Department: *Emergency Department*Daily Work Times: *7p-7:30a*Scheduled Bi-Weekly Hours: *72*Position Summary:*The Registered Nurse delivers quality nursing care through the utilization of the nursing...
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RN - Case Manager
1 week ago
Port Huron, Michigan, United States McLaren USA Full timeJob SummaryAs a Registered Nurse - Case Manager, you will work collaboratively with residents, their families, and facility staff to coordinate high-quality care throughout their stay. You will utilize current RAI manual guidelines to complete the Minimum Data Set (MDS) accurately and timely, ensuring seamless care delivery. Your expertise will serve as a...
Registered Nurse Utilization Management
3 months ago
Position Summary: Responsible for determining the appropriate patient status based on the regulatory and reimbursement requirements of various commercial and government payers in collaboration with the admitting/attending physician. Partners with the health care team to ensure hospital admissions are based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and continued stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays. Reports delays to leadership for resolution. Essential Functions and Responsibilities as Assigned: Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. Collaborates with the health care team to determine the appropriate hospital setting (inpatient vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when appropriate. Works collaboratively with ICM service lines to expedite patient discharge. Screens physician documentation or order entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care, medical necessity, and third-party payer requirement. Documents in the electronic medical record (EMR): clinical reviews (medical necessity), payer authorizations, avoidable days, readmission risks, continued stay reviews and potential discharge date. Utilizes other application tools to document including Veracity, Optum, InterQual, Milliman, etc. Facilitates peer to peer reviews with payer/providers. Actively participates in clinical case review/rounds with the interdisciplinary team regarding continued stays review/LOS outliers, Collaborate with providers/physician advisor when medical necessity and/or appropriateness of care is questioned, in accordance with established SOP procedures. Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer certification, and denied cases. Assists with monitoring the effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed. Assists with orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. Performs other related duties as required and directed. Qualifications: Required ⦁ State licensure as a registered nurse (RN) ⦁ Bachelor’s degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within five years of accepting position. ⦁ Three years of recent nursing or utilization management experience with an acute care hospital Preferred: ⦁ Experience in utilization management/case management, critical care, clinical documentation, or patient outcomes/quality management. ⦁ Certification in Case Management Certification (ACM or CCM) ⦁ Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training Network (MTN)
