Dignity Health

RN Utilization Review

Dignity Health • $80K — $100K *
Santa Cruz, CA 95060In-Person
Hospitals & Medical Centers
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Graduate of an accredited school of nursing
  • Minimum of 2 years of acute hospital clinical experience
  • Bachelor's Degree in Nursing (BSN) or related healthcare field
  • Master's degree in Case Management or Nursing can substitute for 1 year of experience
  • Registered Nurse (RN) license in California

Responsibilities

  • Review medical records for appropriate admission status and hospitalization
  • Collaborate with physicians and Care Coordination staff using evidence-based guidelines
  • Determine root causes of denials with Concurrent Denial RNs and implement prevention strategies
  • Work with Patient Access to verify payer sources and document interactions
  • Obtain inpatient authorization and guide Payer Communications staff to communicate with insurance providers
Full Job Description
Job Summary and Responsibilities

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 evidence-based 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.

Job Requirements

Requirements:
  • Graduate of an accredited school of nursing upon hire
  • Minimum two (2) years of acute hospital clinical experience
  • Bachelor's Degree in Nursing (BSN) or related healthcare field.
  • Masters degree in Case Management or Nursing field in lieu of 1 year experience.

Licensure and Certifications:
  • Registered Nurse: CA (RN:CA

Preferred:
  • years of nursing experience.
  • Accredited Case Manager (ACM)
  • Certified Case Manager (CCM)

About Dignity Health

Dignity Health is a health care provider that operates hospitals and clinics in California, Arizona, and Nevada. The company was founded in 1986 and is headquartered in San Francisco, California. Dignity Health provides a range of services, including emergency care, cancer care, and women's health. The company has over 60,000 employees and is committed to providing high-quality, affordable health care to its patients.
Learn more about Dignity Health
Size
60,000 employees
Industry
Healthcare
Founded
1954
* Ladders Estimates

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