This job was posted by https://www.vermontjoblink.com : For more
information, please see: https://www.vermontjoblink.com/jobs/1147852
Job Type
Full-time
Description
The Utilization Review Registered Nurse (RN) will:
- Assist in determining the appropriate admission status based on the
regulatory and reimbursement requirements of various commercial and
government payers, in conjunction with the admitting/attending
physician.
- Partner with the health care team to ensure reimbursement of
hospital admissions is based on medical necessity and documentation
is sufficient to support the level of care being billed.
- Conduct concurrent reviews as directed in the hospital\'s
Utilization Review Plan and review of medical records to ensure
criteria for admission and continued stay are met and documented.
- Along with other health care team members, monitor the use of
hospital resources and identifies delays.
##### \$10,000 SIGN-ON BONUS FOR EXPERIENCED
PROFESSIONAL#####(External candidates only)
Requirements
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- Associate degree in Nursing from an accredited school
- Bachelor of Science in Nursing (BSN) from an accredited school of
nursing (preferred)
- Three (3) years of recent clinical or utilization management
experience
- Competence in standardized medical necessity criteria (preferred)
- Three (3) years of recent case management or utilization management
experience. (preferred)
- Current Vermont RN licensure in good standing with no restrictions
or stipulations or multistate compact licensure in good standing
with no restrictions or stipulations
- Basic Life Support (BLS) for Healthcare Providers
- Accredited Case Manager (ACM) certification, Certified Case Manager
(CCM) or Case Management Administrator Certification (CMAC)
certification (preferred)
- Ability to understand, interpret, and explain data for utilization
management functions.
- Highly developed written, verbal, and presentation skills.
- Possesses knowledge of care delivery systems across the continuum of
care, including trends and issues in care reimbursement.
- Possesses mid to high-level proficiency in navigating the Electronic
Medical Record and applications related to utilization management.
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