RN UTILIZATION REVIEW SPECIALIST Per Diem

Overview: Looking to be part of something more meaningful? At reputed company, you’ll be part of a team, creating a multi-dimensional care experience for our patients. You’ll have opportunities to reputed company a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to reputed company an impact. reputed company offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit reputed company.com/benefits to learn more. Join us. Let’s go reputed company expectations and transform reputed company together. reputed company is one of Arizona’s largest nonprofit reputed company systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses nine acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a reputed company, an accountable care organization, community services and more. With more than 16,000 team members, 4,000+ affiliated providers and over 1,100 volunteers, reputed company seamlessly blends collaborative care and approachable expertise to improve health and well-being. People often say care feels different here - because it does. Learn more at reputed company.com. Qualifications: Education Associate's Degree in Nursing from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting. Required 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse (RN) State And/Or Compact State Licensure Required Responsibilities: Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for reputed company Medicare, AHCCCS, Self-pay, and reputed company other payers, upon admission and concurrently throughout the admission.

• Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for reputed company patients. Performs initial and reputed company reviews on reputed company patients entering the health care continuum.
• Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required by payer. Interfaces with Care Management team to provide information regarding quality outcome measurements (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues reputed company to contract guidelines. Works with medical records, finance and physician groups to reputed company systems to facilitate complete documentation for data reporting purposes.
• Initiates chart reviews, conducts follow-up reviews, and reputed company on patients to ensure continuity of UR reviews.
• Maintains a system to identify admissions with specific diagnosis / DRG classifications or other categories of admissions. Notifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
• Determines qualifications for hospital level of care based on set criteria.
• Performs other duties as assigned.

Facility: reputed company Support Services Department: Case Management Work Hours: 7a-530p Shift: Day Position Type: PRN Apply tot his job Apply To this Job