Registered Nurse
2 weeks ago
Department: Utilization Management Daily Work Times: 7:00am-3:30pm Shift: Days Scheduled Bi-Weekly Hours: 40 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: 1. 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. 5. Documents in the electronic medical record (EMR): clinical reviews (medical necessity), payer authorizations, avoidable days, readmission risk s, 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. 10. 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. 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)
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Registered Nurse
17 hours ago
Detroit, Michigan, United States McLaren Health Care Full timeDepartment: Bone Marrow TransplantDaily Work Times: VariesScheduled Bi-Weekly Hours:Per DiemPosition 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...
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Registered Nurse
4 weeks ago
Detroit, Michigan, United States Regency at Chene Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Regency at Chene, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package including:Competitive payLife...
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Registered Nurse
1 week ago
Detroit, Michigan, United States Sheffield Manor Nursing and Rehab Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Royalton Manor, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package including:Competitive payLife...
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Registered Nurse RN
2 weeks ago
Detroit, United States Cutiscare LLC Full timeDescription:CutisCare provides management services to wound care and hyperbaric medicine service lines in hospitals nationwide. As a Registered Nurse you will be joining a team of compassionate wound care specialists in positively impacting the patients’ quality of life throughout their healing journey.As a Registered Nurse you will be responsible for:The...
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Registered Nurse RN
1 week ago
Detroit, United States Cutiscare LLC Full timeDescription:CutisCare provides management services to wound care and hyperbaric medicine service lines in hospitals nationwide. As a Registered Nurse you will be joining a team of compassionate wound care specialists in positively impacting the patients’ quality of life throughout their healing journey.As a Registered Nurse you will be responsible for:The...
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Registered Nurse RN
2 weeks ago
Detroit, United States Cutiscare LLC Full timeDescription:CutisCare provides management services to wound care and hyperbaric medicine service lines in hospitals nationwide. As a Registered Nurse you will be joining a team of compassionate wound care specialists in positively impacting the patients’ quality of life throughout their healing journey.As a Registered Nurse you will be responsible for:The...
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Registered Nurse
2 weeks ago
Detroit, United States Vibrus Group LLC Full timeVibrus Group seeks professional registered nurses who are passionate about providing the highest quality of care for patients in a family planning clinic setting . You must have excellent interpersonal communication skills, strong problem solving skills, and the ability to prioritize and multitask under pressure. Positions are available throughout Michigan...
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Registered Nurse RN
2 weeks ago
Detroit, United States Cutiscare LLC Full timeJob DescriptionJob DescriptionDescription:CutisCare provides management services to wound care and hyperbaric medicine service lines in hospitals nationwide. As a Registered Nurse you will be joining a team of compassionate wound care specialists in positively impacting the patients’ quality of life throughout their healing journey. As a Registered Nurse...
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Registered Nurse
3 weeks ago
Detroit, United States Qualicare Nursing Home Full timeDay Shift Only 7:00am-3:30pmAre you a critical thinker, a skilled communicator, and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Qualicare Nursing Home, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefits...
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Registered Nurse
3 weeks ago
Detroit, United States Sheffield Manor Nursing and Rehab Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Royalton Manor, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package including:Competitive payLife...
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Registered Nurse
3 weeks ago
Detroit, United States Regency at Chene Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Regency at Chene, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package including:Competitive payLife...
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Registered Nurse
3 days ago
Detroit, United States V R Della IT Services Private Limited Full timeJob Overview:We are seeking a skilled and compassionate Registered Nurse to join our healthcare team. As a Registered Nurse, you will play a crucial role in providing high-quality patient care and ensuring the well-being of our patients. This is a full-time position in a hospital setting.Duties:- Perform physical examinations and health assessments-...
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Registered Nurse
4 weeks ago
Detroit, United States Qualicare Nursing Home Full timeDay Shift Only 7:00am-3:30pm Are you a critical thinker, a skilled communicator, and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Qualicare Nursing Home, you have the opportunity to use your nursing skills and become a leader. At Ciena Healthcare, we take care of you too, with an attractive benefits...
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Registered Nurse
4 weeks ago
Detroit, United States Sheffield Manor Nursing and Rehab Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Royalton Manor, you have the opportunity to use your nursing skills and become a leader. At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life...
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Registered Nurse
4 weeks ago
Detroit, United States Regency at Chene Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Regency at Chene, you have the opportunity to use your nursing skills and become a leader. At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive...
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Registered Nurse Temporary
4 weeks ago
Detroit, Michigan, United States McLaren Health Care Full timeDepartment: Surgical OncologyScheduled Bi-Weekly Hours: 72Shift: NightsDaily Work Times: 7:00pm-7:30amPosition 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...
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Registered Nurse
1 week ago
Detroit, United States Regency at Chene Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Regency at Chene, you have the opportunity to use your nursing skills and become a leader. At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay ...
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Registered Nurse
4 weeks ago
Detroit, United States Regency at Chene Full timeJob DescriptionAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Regency at Chene, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package...
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Registered Nurse
4 weeks ago
Detroit, United States Sheffield Manor Nursing and Rehab Full timeJob DescriptionAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Royalton Manor, you have the opportunity to use your nursing skills and become a leader.At Ciena Healthcare, we take care of you too, with an attractive benefit package...
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Registered Nurse
4 weeks ago
DETROIT, United States Sheffield Manor Nursing and Rehab Full timeAre you a critical thinker, a skilled communicator and passionate about caring for seniors? Are you seeking career advancement? As a Registered Nurse (RN) at Royalton Manor, you have the opportunity to use your nursing skills and become a leader. At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life...
