Utilization Review RN
Kearny, NJ 07032
Utilization Review Registered nurse (RN)
A great facility is looking for a Utilization Registered Nurse (RN) in Kearny, NJ!
- Perm position with an ASAP start!
- Salary: $70k - $75k
- 40 hours per week.
- Shift: 8:00a – 4:00p
- Perform admission and continued stay reviews on patients to determine the medical necessity or severity of illness and intensity of service for certification of admission and continued stay. This is done utilizing the approved medical management criteria tool i.e. Interqual and ASAM.
- Reviews documentation to verify appropriate patient status based on standardized criteria or RW specific criteria.
- Documents medical necessity for DTX, RTC, PHP and or IOP admission and duration of hospitalization. Collaborates with appropriate interdisciplinary-medical/nursing personnel when medical necessity of Level of care and or continued stay is in question.
- Participates in the development of guidelines and clinical outcome indicators for given population.
- Interface with the Admissions, Leadership and/or MCO to identify correct insurance, coordination of benefits information, effective dates of coverage, pre/admission notifications/authorizations for certification of inpatient admissions and changes in patient class.
- Interface with other members of the health-care team regarding the implementation of discharge planning and the certification/ justification documentation of patient stays, advising them of external/third party requirements and criteria.
- Using the case management data, attempts to recognize issues that potentially cause a denial i.e. poor documentation of SI/IS, avoidable days, delayed discharges, etc.
- Provides education to staff about medical necessity guidelines.
- NJ Registered nurse (RN) license.
- Minimum of 2 years of experience.
Looking for more information on this Registered nurse (RN) opportunity? Please contact Tania Fornelos at firstname.lastname@example.org!
At General Healthcare Resources, we place Registered Nurses (RN), LVN/LPNs, therapists, pharmacists, behavioral health and school-based professionals in per diem, long-term and permanent positions. We offer great pay and one of the best benefits packages in the industry, including:
- Flexible scheduling options
- Personalized service
- Health insurance
- 401(k) investment plan
- Referral bonuses
- Free liability insurance coverage
- Weekly pay
- Direct Deposit or Pay Card option
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.