RN Utilization Management Specialist

3 weeks ago


Newport News, Virginia, United States Riverside Health System Full time
Job Summary

Riverside 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 authorization for services.

Key Responsibilities

Conduct initial and concurrent reviews on all patients who occupy a bed
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
Respond to requests for clinical information in a timely manner and collaborate with Insurance Verification department

Requirements

3-4 years of clinical nursing experience
Registered Nurse (RN) licensure in the state of Virginia
Bachelor's degree in Nursing (preferred)

About Riverside Health System

Riverside Health System is a leading healthcare provider in the region, dedicated to delivering high-quality patient care and services. We offer a dynamic and supportive work environment, with opportunities for professional growth and development. If you are a motivated and compassionate RN with a passion for utilization management, we encourage you to apply for this exciting opportunity.

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