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Registered Nurse RN Utilization Review

Company: HCA Healthcare
Location: Richmond
Posted on: December 6, 2019

Job Description:

SHIFT: Days (rotating weekends) SCHEDULE: Full-time SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS: This position will focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services and application of treatment protocols. A team approach with the facility Case Management team is critical. * Perform admission InterQual as per Plan contract or within 24 hours on all Non-Medicare Inpatients and document in Midas. * Will work with UR Manager, Denial Manager and Capital Division CM Director to implement process improvements to impact denials, LOS opportunities, improve provider relations etc. * Document note to support Inpatient admission. * Ensure the patient s status is correct (Inpatient vs Outpatient) * Perform continued stay InterQual as per Plan contract, a minimum of every 3 days and submit to the Plan as needed. * Review concurrent denials and work with facility, physician and Plan to overturn the denial, document in Midas Denied Days screens. * Communicate denial status to the facility and physician. * Follow X-Code process as per HCA policy. * Communicate with physicians regarding patient status. * Communicate medical necessity and responder criteria to the facility Case Manager. * Review the Certification / Authorization report daily to determine deficiencies. * Documentation to take place in Midas in the Care Enhance Review Manager Enterprise (CERME), Midas Certification Entry, Midas Concurrent Review Entry and the Avoidable Denied Days module. Education Qualifications B.S. in Business Administration, Nursing or Healthcare Administration preferred or equivalent work experience. EXPERIENCE: Meditech EMR experience REQUIRED Minimum 2 years experience in case management/utilization review required. InterQual experience required, minimum of one year. Acute care hospital experience preferred. Third Party Payer and Denial Management experience a plus. Experience with Midas (or other utilization review programs) Hours Schedule flexible as per UR department needs. Ability to work weekends, holidays, evenings as needed from Why join HCA CJW Medical Center? o Matching 401K o Low Deductibles for Health, Vision, and Dental o Team Culture o Passion for patient care o Career Advancement through Clinical Ladder o Relocation Assistance o Tuition Reimbursement Program($5,250/calendar year) o Student Loan Assistance Program($1,800/calendar year) We are an equal opportunity employer and we value diversity at our company We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Notice Our Company s recruiters are here to help unlock the next possibility withi your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, contact us at *************************

Keywords: HCA Healthcare, Richmond , Registered Nurse RN Utilization Review, Healthcare , Richmond, Virginia

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