Register
Recruit Create CV
Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Travel Rn - Case Management
Recruited by TactStaff 8 months ago Address Falls Church, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Trust Point Inc. 8 months ago Address Fredericksburg, VA, United States
Utilization Review Nurse-Weekends Jobs
Recruited by Sentara Healthcare 8 months ago Address , Virginia Beach, 23462
Utilization Review Nurse - Outpatient
Recruited by Johns Hopkins Health Plans 8 months ago Address , Hanover
Team Coordinator, Behavioral Health Utilization Review
Recruited by Sentara Healthcare 9 months ago Address , Norfolk, 23502
Utilization Review Nurse Pchp-(Ft/Days)
Recruited by Centra Health 9 months ago Address , , Va
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Chesapeake, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Newport News, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Portsmouth, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Henrico, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Petersburg, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 10 months ago Address Richmond, VA, United States
Full-Time: Rn Liaison Jobs
Recruited by Hospice Of Davidson County 10 months ago Address Lexington, NC, United States
Hospice Patient Care Manager, Rn - Full Time
Recruited by Gentiva Hospice 11 months ago Address Wytheville, VA, United States
Travel Rn - Case Management
Recruited by KPG Healthcare 11 months ago Address Charlottesville, VA, United States
Admission Rn - Registered Nurse - Full-Time
Recruited by Care Advantage, Inc. 11 months ago Address Virginia Beach, VA, United States
Utilization Review Nurse - Inpatient
Recruited by Johns Hopkins HealthCare 11 months ago Address , Hanover, 21076, Md
Utilization Managment Nurse Consultant
Recruited by CVS Health 1 year ago Address , Chantilly, Va $28.25 - $60.50 an hour
Care Review Clinician, Inpatient Review Lpn
Recruited by Molina Healthcare 1 year ago Address , Richmond, Va $24.00 - $46.81 an hour
Utilization Nurse Jobs
Recruited by US Veterans Health Administration 1 year ago Address , Bedford, 01730, Ma $82,321 - $162,414 a year
Utilization Review Nurse Jobs
Recruited by Sentara Healthcare 1 year ago Address , Norfolk, 23502, Va
Utilization Review Nurse Jobs
Recruited by Sentara Healthcare 1 year ago Address , Newport News, 23601, Va
Review Appraisers Jobs
Recruited by All Native Group 1 year ago Address , Arlington, 22209, Va

Rn Utilization Review Full Time Rrmc

Company

Riverside Regional Medical Center
Address , Newport News, 23601, Va
Employment type FULL_TIME
Salary
Expires 2023-06-26
Posted at 1 year ago
Job Description
Newport News, Virginia
For over 100 years, at Riverside Health System, we have made it our mission to care for others as we would care for those we love.
This position is located on site at Riverside Regional Medical Center in the Emergency Department working 12 hour shifts.
Responsible for ensuring cost-effective patient care services are being delivered, monitoring and reviewing the documentation for medical necessity for admission and continued stay, and communicating with payers to ensure authorization for services is obtained for appropriate reimbursement. Provides a comprehensive range of utilization review services associated with and in accordance with standards of excellence and standards of the UM Plan established by Riverside Health System, facility goals and strategic plans.
What you will do
  • Maintains knowledge and understanding of Medicare/Medicaid regulatory requirements and Conditions of Participation. Completes quarterly verification of competency via assigned MCG Interrater Reliability cases and actively participates in review discussions.
  • Accurately manages authorizations for acute medical services for assigned cases and ensures the correct level of care is reflected in the authorization requested. Responds to requests for clinical in a timely manner, ensuring no denials for Lack of Information are received. Collaborates with Insurance Verification department to communicate changes in level of care and coverage. Ensures all concurrent denials are addressed in a timely manner, communicating with the Physician Advisor and Attending Provider as necessary. Documents appropriately in the electronic medical record.
  • Openly communicates with Care Coordinators to include notification of avoidable days, changes in level of care, denials of authorization, and changes in coverage, etc. Documents this notification in the electronic medical record.
  • Collaborates openly with Physician Advisors when seeking guidance on level of care determinations, peer to peer discussions, and denial management. Accurately documents all referrals in the electronic medical record to ensure accurate capture data.
  • Completes initial and concurrent reviews on all patients who occupy a bed. Assesses patient records as assigned for medical necessity utilizing Medicare's Two Midnight Rule & MCG guidelines as review criteria. Accurately documents justification for level of care within the review citing specific clinical information as necessary. Ensures physician order is appropriate for the documented level of care. Documents avoidable days in the electronic health record as appropriate.
  • Manages all denials concurrently. Collaborates with the Physician Advisors and Attending Providers to ensure compliance with issues relevant to non-coverage/possible denials. Assists in the scheduling of peer to peer discussions and relays this information to the appropriate provider. Accurately documents all information in the electronic medical record and documents outcomes and steps for next level of appeal as necessary.

Qualifications
Education
  • Bachelors Degree, Nursing (Preferred)
  • Program Graduate, Professional Nursing (Required)

Experience
  • 3-4 years Clinical nursing experience (Required)

Licenses and Certifications
  • Registered Nurse (RN) - State Department of Health Professions (Required)
  • This position is located on site at Riverside Regional Medical Center in the Emergency Department working 12 hour shifts.
As a Riverside Health System team member, our benefits have you covered:
Health & Wellness:
  • Wellness & fitness center discounts
  • Onsite pharmacy and delivery options
  • Vision and Dental plans (including orthodontic care)
  • Medical Plan Options
  • Healthy lifestyle incentives
  • Riverside Health System services discount
  • Flexible spending and savings accounts
Peace of Mind:
  • Pet Insurance
  • Legal Insurance
  • Group Term Life and AD&D Insurance
  • Short Term Disability
  • Accident Insurance
  • Critical Illness Insurance
  • Whole Life Insurance
Financial Support:
  • Employee Help Fund
  • Specialty Certification Financial Assistance
  • 403(b) Savings Plan (Immediate Matching)
  • Company Wide Bonus Program
  • CEUs (MedBridge Education)
Work-Life Balance:
  • Community involvement opportunities
  • Area retail discounts
  • Paid Time Off (full- and part-time team members)
  • Extended illness bank
  • Adoption Assistance
  • Care.com membership
  • Employee Assistance Program