Utilization Review Rn Care Coordination Full Time

Job Description
Full time, 10a-10p every third weekend 12-8. Working in the Emergency Department.
The Utilization Management RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Utilization Management nurse role is to ensure that health care services are administered with quality, cost efficiency, and within compliance by continuously reviewing the EMR and collaborating with the health care team.
Responsibilities:
Concurrent review of patients clinical information for efficiency and correct level of care and admission status
Interface with payers concurrently and after discharge to obtain authorization
Concurrent denials management
Collaborates with the denials management team
Ongoing review of pre-certification requests for medical necessity
Monitor the activities of clinical and non-clinical staff
Collaborates with the health care team and payers to assist with coordinating patients discharge planning needs
Employ effective use of knowledge, critical thinking and skills
Work in an intensive, fast-paced environment with minimal supervision
Ability to stay organized and interact well with others in any situation
Provide updates to Director of Utilization Management for review
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