Utilization Review Rn - Carmichael, United States - Mercy San Juan Medical Center

Mercy San Juan Medical Center

Verified Company

Carmichael, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Overview

Dignity Health Mercy San Juan Medical Center is a 370-bed not-for-profit Level 2 Trauma Center located in Carmichael California serving the areas of north Sacramento County and south Placer County for more than 50 years.

It is one of the area's largest and most comprehensive medical centers. Dedicated to the community's well-being our staff and volunteers provide excellence in care for our patients each year. Mercy San Juan Medical Center has received recognition for being a Comprehensive Stroke Center and Center of Excellence for Bariatric Surgery along with Certificates of Excellence in Perinatal Care Hip
- and Knee

Replacement.

Responsibilities
**_

Utilization Review RN - remote position_**
Position Summary:The incumbent is responsible for the review of medical records for appropriate admission status and continued hospitalization.

Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidencebased guidelines and critical thinking.
Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies.
Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions.
Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.

Knowledge/Skills:

Understand how utilization management and case management programs integrate.
Must have critical thinking and problemsolving skills.
Thrive in a fast paced, selfdirected environment.
Knowledge of CMS standards and requirements.
Highly organized with excellent time management skills.

We offer the following benefits to support you and your family:

Health/Dental/Vision Insurance
Flexible spending accounts
Voluntary Protection: Group Accident Critical Illness and Identity Theft
Adoption Assistance
Employee Assistance Program (EAP) for you and your family
Paid Time Off (PTO)
Tuition Assistance for career growth and development
Retirement Programs
Wellness Programs

Qualifications Minimum**:

Current CA RN licensure
Two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience

Preferred: