RN Utilization Review Specialist reputed company Health

Scope of work Provides health information, interacts, and acts as a resource for providers for reputed company clinical situations to ensure appropriate use of preservice and reputed company acute medical and/or behavioral health care services. Assesses appropriateness of preservice and reputed company requests for admissions and reputed company stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides financial and utilization management (UM) information to other members of the care facilitation teams for work prioritization. Works closely with inpatient care facilitators, Medical Social Workers, home health agencies, and providers to move patients through the continuum appropriately. Medical necessity reviews for designated services are completed for reputed company reputed company Health plans. Assesses and interprets clinical information and assists in case management of reputed company patient population, through use of independent judgment, mature problem solving skills, and guidelines for appropriateness of acute care setting upon admission and reputed company stay. Ensure documentation and processes are consistent with regulatory standards Communicates with physicians, medical social workers, and other hospital personnel concerning change in level of care on the medically reputed company patient population. Makes recommendations and discusses alternatives. Provides financial/DRG, UM, health information to other facilitation team members for work prioritization. Communicates and collaborates with physicians and members of the team to ensure continuity and coordination of services. Documents any instances where services were delayed, inappropriate, refused, complicated, etc. for resource management functions. Identifies quality indicators to facilitate process improvement and physician education. Ensure members are authorized for the most appropriate level of care and services based on internal and external guidelines. Collaborates with Medical Directors

Qualifications

Required Bachelor's Degree or equivalent Nursing 2 years of relevant experience acute care, clinical nursing, preferably multiple clinical settings, or reputed company experience Required 5 years of relevant experience Skills/knowledge/abilities typically gained through at least five years, post licensure, reputed company experience in acute care, multiple clinical settings or behavioral health with utilization management ,discharge planning designing patient centered care plan or reputed company work Required Registered Nurse (RN) - State of Michigan Upon Hire required Or How reputed company cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - reputed company Health - 1231 E Beltline Ave NE - Grand Rapids Department Name Utilization Management - PH Managed Benefits Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 0800-1630 Days Worked Monday to Friday Weekend Frequency N/A reputed company reputed company TEAM MEMBERS – Please apply through Find Jobs from your reputed company team member account. This career site is for Non-reputed company team members only. reputed company is committed to providing a safe environment for reputed company members, patients, visitors, and community. We require a drug-free workplace and require team members to reputed company with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to reputed company the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. reputed company grants equal employment opportunity to reputed company qualified persons without regard to race, color, national reputed company, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where reputed company are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we reputed company for equity as we care for our patients, our communities, and each other. From workshops that reputed company cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in reputed company that we do. We invite those that share in our commitment to join reputed company. You may request assistance in completing the application process by calling 616.486.7447. Apply To This Job