Requisition ID:

3140 Utilization Review RN - Per Diem•

IMPORTANT NOTE

In lieu of benefits due to \"per diem\" status, 15% will be added to the hourly rate. Per diem employees are offered work on an \"as-needed\" basis.

POSITION SUMMARY

Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal regulations, insurance company requirements for reimbursement.

POSITION REQUIREMENTS

Minimum Education A Bachelor's Degree in Nursing preferred; three (3) years of clinical care or nursing experience; OR an equivalent combination of education and experience AND (2) two years' experience Utilization Review. Certificate Preferred CCM (certification in case management) is preferred. License Required Must be licensed as a Registered Nurse by the State of Nevada, and remain active with all annual licensing requirements. Minimum Work Experience Minimum of 1 year of case management or utilization management experience.\nKnowledge of InterQual or McKesson criteria preferred. Knowledge in conducting a medical record review for medical necessity.\nKnowledge of basic

ICD-10, CPT

coding knowledge preferred.\nBasic knowledge of regulations as set forth by The Centers for Medicare Medicaid Services.\nSkill in operating a personal computer utilizing a variety of software applications.\nStrong written and oral communication skills\nSkill and ability to work independently

POSITION ESSENTIAL FUNCTIONS

Chart Review Conducts chart review to determine that InterQual-based care criteria is met.\nAssist in determining if patients are in the correct hospital setting\nReview elective surgery schedule\nReview outpatient charts (observation)\nObtains appropriate patient records as required by payor agencies and initiates the UR Medical Director as necessary for unwarranted admissions Hospital Reimbursements Understand and demonstrates the requirements needed to maximize reimbursement to the hospital\nAssist in obtaining authorizations as needed; including follow-up\nRespond to insurance providers in a timely and thorough manner\nCommunicates with various hospital departments in a meaningful manner\nAssists in ensuring appropriate room charges, patient status, discharge disposition, etc.\nReviews denials and collaborates on appeals of denials\nCommunicates with HIM staff and resolves discrepancies Knowledge Condition 44 documentation and requirement; HINN notification letters, ABN-advance beneficiary notice, Important Letter from Medicare, etc\nMaintains practices consistent with the hospital's utilization review (UR) plan\nReviews the plans components and is a member of the utilization review committee\nObtains data and statistics addressed in the hospital's UR plan and presents information as needed\nEnsures appropriate and cost-effective healthcare services to patients Documentation Demonstrates understanding and supports clinical documentation improvement strategies\nAbility to efficiently locate priority clinical information in a medical record, and to critically interpret that information as part of a treatment plan.\nAnalyze clinical information to identify areas with potential for documentation improvement\nDemonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.\nDemonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.\nReviews medical records concurrently, recognizes opportunities for documentation improvement, and follows up with appropriate staff.\nFacilitates modifications to clinical documentation through collaborative interactions with physicians, nurses, and ancillary staff.

CARSON VALLEY HEALTH IS PROUD TO BE RECOGNIZED AS A FINALIST IN THE

BEST PLACES TO WORK

\" - NORTHERN

NEVADA, 2021, 2022, 2024, 2025 & 2026!

LOOK FORWARD TO WELCOMING YOU TO OUR TEAM!

! Per Diem positions have no guaranteed hours or set schedule. 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