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PRN Utilization Management Nurse (Hybrid)

University Hospitals • Per Diem • Shaker Heights, OH, US • 3w ago

Description

Position Summary

Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:Support of positive patient health care outcomesIncreased patient/health care team outcomes and satisfaction Improved inpatient throughput and appropriate length of stay Improved communication, awareness and adherence to regulatory requirements associated with utilization management Support for appropriate level of care and decreased inpatient bed day denialsContinuity and coordination of care Appropriate and timely authorization for level of care Decreased denials Appropriate reimbursement

Essential Functions

Performs timely and accurate admission and continued stay review in accordance with department policy to ensure efficient use of hospital resources, timely discharge and optimal, appropriate reimbursement (includes communication with internal and external customers).
Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to promote timely and effective communication, completion of workflow and services with regard to level of care decisions and payor decisions regarding continued stay.
Documents review activity, including but not limited to, application of criteria or policy as appropriate, clinical review to submit to insurance providers, initiation of registration changes when appropriate, outcomes and cost savings in a manner consistent with department requirements.
Meets department productivity and quality standards.

Required For All Jobs

Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications

Qualifications

Education

Graduate of an accredited school of Nursing Required and
Bachelor’s Degree Preferred

Work Experience

3+ years of clinical experience (acute care) Required and
Additional experience in sub-acute setting, or managed care Preferred and
2+ years of clinical experience with the population to be served. (recommended) Required and
Experience with Interqual or MCG criteria Preferred

Knowledge, Skills, & Abilities

Must have sound clinical knowledge base of the population to be served. Required
Knowledge of Medicare, Medicaid and commercial payer regulations Preferred
Detail-oriented and organized, with good analytical/critical thinking skills and problem solving ability. Required
Ability to function independently and as a team player in a fast-paced environment Required
Must have strong written and verbal communication skills. Required
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) Required
Demonstrated ability to apply concepts, utilize sound judgment and work independently within a framework of guidelines Required

Licenses and Certifications

Registered Nurse (RN) in the State of Ohio Required

Additional Licenses And Certifications

CM certificate Preferred
in the State of Ohio Required

Physical Demands

Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely 20 lbs
Carrying Rarely 20 lbs
Pushing Rarely 20 lbs
Pulling Rarely 20 lbs
Climbing Rarely 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently

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