Registered Nurse - Mid Shift ED UM RN - 12 Hour Days

Summary of Essential

Duties

• Validate patients' placement to be at the most appropriate level of care based on nationally accepted admission criteria
• Use medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay
• Secure authorization for clinical services through timely collaboration and communication with payers as required
• Follow the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review
• Collaborate with Care Coordinators to identify and follow up on Observation class patients
• Follow up with the payer to verify approval/authorization of the hospital stay (all dates of services)
• Function as an advocate, and contact person for the care team, patient/family when communicating with payers, and or outside agencies to ensure continuity of care, optimal clinical resource outcomes, and appropriate financial management for the patient and the organization

Qualifications

Educational

Requirements

Assoc. Degree/College Diploma Graduate of an accredited RN nursing program required

Bachelor's Degree Nursing preferred

Licenses

RN State License

Basic Life Support (BLS)

Experience

3 years In acute nursing required

2 years Case Management preferred

1 year CPT coding preferred

Knowledge of medical literature, research methodology, health care delivery systems and financial reimbursement required