RN Utilization Management Specialist
2 weeks ago
We are seeking a skilled RN Utilization Management Specialist to join our team at Riverside Health System. This is a part-time, on-site position working 12-hour shifts in the Emergency Department at Riverside Regional Medical Center.
Key Responsibilities- Ensure cost-effective patient care services are delivered by monitoring and reviewing documentation for medical necessity of admission and continued stay.
- Communicate with payers to obtain authorization for services and ensure appropriate reimbursement.
- Provide comprehensive utilization review services in accordance with standards of excellence and facility goals.
- Assess patient records for medical necessity using Medicare's Two Midnight Rule and MCG guidelines.
- Accurately document justification for level of care and ensure physician orders are appropriate.
- Manage authorizations for acute medical services and ensure correct level of care is reflected in the authorization requested.
- Respond to requests for clinical information in a timely manner to avoid denials.
- Collaborate with Insurance Verification department to communicate changes in level of care and coverage.
- Address concurrent denials in a timely manner and communicate with Physician Advisors and Attending Providers as necessary.
- Program Graduate, Professional Nursing (Required)
- 3-4 years Clinical nursing experience (Required)
- Registered Nurse (RN) - State Department of Health Professions (Required)
Riverside Health System is a leading healthcare provider in the region, dedicated to delivering high-quality patient care and services. We are committed to creating a positive and supportive work environment for our team members.
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RN Utilization Management Specialist
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Newport News, Virginia, United States Riverside Health System Full timeJob SummaryRiverside Health System is seeking a skilled RN Utilization Management Specialist to join our team in the Emergency Department. As a key member of our team, you will be responsible for ensuring cost-effective patient care services are delivered, monitoring and reviewing documentation for medical necessity, and communicating with payers to obtain...
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RN Utilization Management Specialist
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