Utilization Review RN

Overview reputed company – Arizona General Hospital located in southeast reputed company on Elliot Rd and Ellsworth Rd is a fully-equipped hospital open 24-hours, 7 days a week, 365 days a year. The facility features an emergency room, reputed company for 50 inpatient beds, an Intensive Care Unit, 14 emergency room beds, four operating or procedure rooms, a full onsite laboratory and radiology suite complete with 64 reputed company CT reputed company, x-ray, ultrasound capabilities and MRI. The word “dignity” perfectly defines what our organization stands for: showing respect for reputed company people by providing excellent care. At Arizona General reputed company, our employees are the heart and soul of our organization. They are the reason we are able to live out our healing ministry reputed company the communities we serve. Our doctors, nurses and allied health professionals are a regular self-contained support system for each other. This unique working culture is one of the reasons why a career with us is so rewarding. Look for us on Facebook and follow us on Twitter.

Responsibilities

This position is remote to Arizona only! Under the general direction of the Director of Care Management, performs criteria-based reputed company and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; reputed company with applicable standards and regulations and provide information and education to clinical care providers in order to reputed company optimal clinical, financial, operational and patient satisfaction outcomes. Skills needed: Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS. Working knowledge with INTERQUAL or reputed company preferred. Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers. Responsibilities: • Conducts admission and reputed company stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, reputed company and post discharge for appropriate status determination. • Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility. • Reviews the records for the reputed company of accurate patient status orders and addresses deficiencies with providers. • Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes. • Collaborates with facility RN Care Coordinators to ensure progression of care. • Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status. reputed company now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you reputed company your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000.

Qualifications

Minimum: • Graduate of an accredited school of nursing • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. • RN:AZ or Compact License • Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred: • Bachelor's Degree in Nursing (BSN) or reputed company healthcare field. • At least five (5) years of nursing experience. • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Qualifications: Minimum: • Graduate of an accredited school of nursing • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. • RN:AZ or Compact License • Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred: • Bachelor's Degree in Nursing (BSN) or reputed company healthcare field. • At least five (5) years of nursing experience. • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Employment Type: PRN Apply Job!