Utilization Review Rn - Phoenix, United States - St Joseph Hospital & Medical Center

St Joseph Hospital & Medical Center

Verified Company

Phoenix, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Overview Hello humankindness**Located conveniently in the heart of Phoenix, Arizona, St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved.

We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute, Norton Thoracic Institute, Cancer Center at St. Joseph's, Ivy Brain Tumor Center, and St. Joseph's Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph's is considered a sought-after destination hospital for treating the most complex cases from throughout the world.

Every day, approximately 20 percent of the hospital's patients have traveled from outside of Arizona and the United States to seek treatment at St.

Joseph's.

U.S News & World Report_ routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital.

St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of _Arizona's Most Admired Companies_.

Look for us on Facebook and follow us on Twitter.

For the health of our community... we are proud _to be _a tobaccofree campus._

Responsibilities

This position is remote to Arizona only

Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; comply with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical, financial, operational and patient satisfaction outcomes.

Skills needed:
Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS. Working knowledge with INTERQUAL or Milliman preferred.

Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers.

Responsibilities:

Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, concurrent and post discharge for appropriate status determination.
Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
Collaborates with facility RN Care Coordinators to ensure progression of care.
Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.

Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000.

Qualifications

Minimum:

Experience:

Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience

Education: