Position Summary: Performs medical record review for severity of illness and intensity of service; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement; identifies variance from established pathways
Essential Duties and Responsibilities:
- Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical database
- Monitors all levels of care for appropriateness and communicates variance; evaluates plan of care to ensure it is based on accepted standards
- Provides information to external review organizations, documents pertinent communications
- Refers to designated physician advisor those patients not meeting criteria as well as quality of care concerns
- Maintains knowledge and incorporates current standards into practice
Required Qualifications: Knowledge of clinical norms; excellent communication skills; critical thinking skills; organized and efficient time management skills
Education and Training:
- Nurse, Registered (RN) licensure
- BSN preferred. 2-5 years previous Utilization Review experience preferred.
- Current CPR
- Relevant hospital nursing; hospital case management; insurance case management or utilization management experience preferred
Work Shift Details:
Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site requirement for meetings and mandatory training
Department:
CONTINUUM OF CARE
Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:
· Medical, Dental and Vision plans
· Life Insurance
· Flexible Spending Account
· Other voluntary benefit plans
· PTO and Sick time
· 401(k) plan with a match
· Wellness program
· Tuition Reimbursement
Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match. However,registry employees are ineligible for Health and Welfare benefits.
The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.
The expected pay for this position is listed below:
$34.73 - $45.15
