Utilization Review RN Per Diem - New Brunswick - Saintpetershcs

    Saintpetershcs
    Saintpetershcs New Brunswick

    1 week ago

    Description

    Utilization Review RN Per Diem

    Clinical Document-Coding Management

    Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of this recognition, awarded to organizations that demonstrate exceptional performance in nursing practices and patient outcomes. Our team of award?winning nurses is growing, and we are looking for talented, compassionate RNs to join our team.

    Responsibilities

    • Identify appropriate medical information necessary to certify and/or refer cases on admission and on continued stay reviews.
    • The review of the medical record includes all pertinent information required by insurance payers including the reason for admission, current symptoms, abnormal lab values, abnormal diagnostics, outpatient condition prior to an admission and response or lack of response to such treatment. Review medication administration record to identify antibiotics administered, dose and frequency, respiratory treatments, medical/surgical and social history. Documentation if discharged from a hospital within 30 days, as well as any pertinent clinical information.
    • Perform assigned admission reviews within established time frame in accordance with payer requirements as well as daily reviews for Medicare, Medicaid and managed care companies per their requirements.
    • Ensure timely provision of clinical review information to payer as evidenced by no denials for lack of clinical information. Collaborate with patient registration/resource services for issues related to insurance coverage (i.e., correct insurance is not in patient record).
    • Whenever possible, manage requests for concurrent reconsiderations as evidenced by the "overturn" of the initial denial decision.
    • Initiate collaboration with the Medical Staff or Clinical Documentation Specialists by identifying additional clinical information required for obtaining payer determination for approval of the admission.
    • Identify hospital stays at risk for admission downgrades or denials and involve the Physician Advisor in a timely fashion when assistance is needed.
    • Refer cases to the Physician Advisor when a change in level of care or termination of benefits seems applicable based upon criteria for Medicare/Medicaid patients (i.e., certification of acute days versus custodial or SNF).
    • Utilize case management software including utilization criteria guidelines, to capture essential admission clinical review documentation.

    Qualifications

    • Registered nurse currently licensed to practice in the State of New Jersey.
    • Required to have three (3) to five (5) years?nursing experience working in an acute care hospital setting, preferably medical/surgical or critical care.
    • Experience should include assessment of a patient's diagnosis, prognosis, care needs responsible for a patient admission.
    • Ability to clinically assess the patient condition for establishing medical necessity justifying an inpatient admission by analyzing medical records, interpreting clinical and laboratory data.
    • Must have excellent interpersonal, communication, organizational and computer skills.
    • Flexible and able to work independently and part of a team.

    Benefits and Compensation

    We offer competitive base rates that are determined by many factors, including job?related work experience, internal equity, and industry?specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials. The salary range listed for exempt positions reflects full?time compensation and will be prorated based on employment status.

    Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back?up daycare, free onsite parking, and recognition rewards.

    Learn more about our benefits by visiting our site at Saint Peter's.

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