Registered Nurse Only

***Recruiting/Signing Bonus Available***

Primary focus on inpatient acute care hospital authorizations for the rehabilitation program

• Reviews daily the medical records of all observation, surgical and medical admissions to the hospital to determine the medical necessity for admission and continued stay.
• Reviews all requests for elective medical admissions for appropriate utilization and necessary patient-care planning prior to admission.
• Obtains inpatient acute care hospital authorizations for patients requiring inpatient stay.
• Reviews inpatient census, daily, for admission and observation status, and facilitates any updates, as needed.
• Responsible for preparing utilization review reports and documents for the Hospital Utilization Review Management Program.
• Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals as necessary.
• Works with staff (physicians, nursing, and patient access) to ensure correct observation/admission orders are written.
• Continues review of all patients using criteria and determines need for continued hospitalization based upon third-party payer/insurance guidelines.
• Based on third party payers/insurance guidelines, communicates as required for continued stay review.
• Working knowledge of severity of illness and intensity of service factors to determine alternative levels of care.
• Advocates for the patient and hospital with third-party payers to secure appropriate payment for services rendered.
• Prevents denials and disputes by communicating with third-party payers and documenting relevant information. Files for inpatient and observation appeals as a result of third-party payer denial or obtaining authorization in coordination with the Revenue Cycle Manager.
• Establishes and maintains effective communication with all referral sources, insurers, vendors, and patient supplier systems.
• Interacts, communicates, and intervenes with multidisciplinary healthcare team in a purposeful, goal-directed fashion. Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization and discharge planning.
• Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes communicating information through clear, complete, and concise documentation.

Job Type: Full-time

**COVID VACCINE OR EXEMPTION REQUEST REQUIRED**

Job Type: Full-time

Pay: From $45.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Medical-Surgical
• Surgery

Physical setting:

• Acute care
• Hospital
• Inpatient
• Outpatient

Schedule:

• Day shift
• Monday to Friday

Work Location: One location

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