RN Utilization Review (PRN)
Washington, District of Columbia
Employer: Medstar
Industry: Nursing
Salary: Competitive
Job type: Part-Time
Are you an experienced Utilization Review Nurse looking for a PRN position to include some weekends? MedStar Health Washington Hospital Center is seeking a PRN UR Nurse to fill in as needed to include some weekends.
Position Overview
Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate completion of utilization review using payer specific criteria; uses Interqual and MCG to determine medical necessity and appropriateness of inpatient or observation status ; serves as communication liaison between registered nurse case managers, social workers, on-site reviewers, patient financial services, outpatient areas and registration; and performs all functions in accordance with all applicable laws, regulations and MedStar Washington Hospital Center's philosophy, policies and standards.
Key Responsibilities
Conducts admission, concurrent, and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way
Strives to meet the department goals, adheres to organizational policies, procedures, and quality standards. Complies with rules and regulations set forth by the governmental and accrediting agencies.
Collaborates with medical staff, physician advisor, social workers, and other ancillary hospital disciplines to meet patients' health care needs in the most cost-effective way.
Performs patients' medical record reviews, document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.
Implements strategies to avoid potential denials by communicating with all the key stakeholders including attending physician.
If necessary, non-coverage, ABN, MOON letters, and other appropriate documents as per organizational, governmental, and accrediting organizations policies and regulations.
Qualifications
Associate's degree in nursing Required
Bachelor's degree in nursing Preferred
3 or more years of experience in an acute care setting Required
2 or more years of experience in Case Management, Insurance, Utilization Review or related is strongly preferred
Active DC License
CCM Certification preferred
","industry":"Healthcare
Position Overview
Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate completion of utilization review using payer specific criteria; uses Interqual and MCG to determine medical necessity and appropriateness of inpatient or observation status ; serves as communication liaison between registered nurse case managers, social workers, on-site reviewers, patient financial services, outpatient areas and registration; and performs all functions in accordance with all applicable laws, regulations and MedStar Washington Hospital Center's philosophy, policies and standards.
Key Responsibilities
Conducts admission, concurrent, and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way
Strives to meet the department goals, adheres to organizational policies, procedures, and quality standards. Complies with rules and regulations set forth by the governmental and accrediting agencies.
Collaborates with medical staff, physician advisor, social workers, and other ancillary hospital disciplines to meet patients' health care needs in the most cost-effective way.
Performs patients' medical record reviews, document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.
Implements strategies to avoid potential denials by communicating with all the key stakeholders including attending physician.
If necessary, non-coverage, ABN, MOON letters, and other appropriate documents as per organizational, governmental, and accrediting organizations policies and regulations.
Qualifications
Associate's degree in nursing Required
Bachelor's degree in nursing Preferred
3 or more years of experience in an acute care setting Required
2 or more years of experience in Case Management, Insurance, Utilization Review or related is strongly preferred
Active DC License
CCM Certification preferred
","industry":"Healthcare
Created: 2024-08-22
Reference: req31657
Country: United States
State: District of Columbia
City: Washington
ZIP: 20010
Similar jobs:
-
RN Nurse Manager Utilization Review
Children's National Hospital in Washington, District of Columbia -
RN Utilization Review
Medstar in Washington, District of Columbia -
Utilization Review Nurse
Medix in Washington, District of Columbia