Minimum Hiring Wage:From $39.37 per hour
Job Details:Scheduled Hours: Days | 8:00am - 4:30pm |
Every 7th Weekend 8:00am - 8:30pm
Job Description:- Associate degree in nursing (ADN) Required
- Licensed Registered Nurse in the State of Iowa Required
- Bachelor's Degree in related field Preferred
A Brief Overview- Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.
What you will do
- Review inpatient encounters for medical necessity-Accurate and timely record review.-Gather and analyze clinical documentation to formulate an outcome.-Making decisions based on facts and evidence; assuming responsibility for those decisions.-Monitor cases for medical necessity/level of care.-Accurate input of data.-Manage multiple priorities.-Remains current with medical and surgical procedures, products and general trends in health care delivery.-Adhere to all state and Federal regulations for all UM reviews.-Practice utilization management activities within the scope of practice.
- Excellent Communication Skills-Effective and appropriate communication with physicians and insurance providers for the medical necessity of healthcare services.-Work incoming calls from patients, insurances, providers and facilities promptly.-Cooperate and work effectively with all department and staff to facilitate services to members and providers of care.-Maintain continuous, effective communication with other departments/disciplines.-Effective communication with patients and families regarding level of care and CMS guidelines
- Participates in continuous quality improvement activities. Facilitates appropriate cost effective and cost containment measures.
- Knowledge of electronic health record and software-Competent in Excel, Outlook and SharePoint-knowledge and ability to use web browser
Qualifications:Qualifications- 4-6 years clinical experience Required
- Previous experience in Utilization Review Preferred
- Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- Knowledge of Utilization Management methods, principles and techniques.
- Knowledge of types of providers and services available for patients.
- Managing one's own time to ensure effective Utilization Management.
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Being aware of others' reactions and understanding why they react as they do.
- Adjusting actions in relation to others' actions.
- Talking to others to convey information effectively.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Understanding written sentences and paragraphs in work related documents.
- The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
- The ability to listen to and understand information and ideas presented through spoken words and sentences.
- The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
- The ability to communicate information and ideas in speaking so others will understand.
- The ability to work cooperatively and effectively with other professionals in a team situation.
- The ability to collect and analyze information.
- The ability to make decisions relating to services provided to consumers.
- The ability to develop a logical and practical plan.
- The ability to evaluate the progress of patients.
- The ability to mediate with providers and other staff to resolve problems.
- The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
- The ability to identify and understand the speech of another person.
- Registered Nurse Iowa Board of Nursing (IBON) (United States of America) Upon Hire Required
Benefits:We are excited to offer an aggressive compensation and benefits package for qualifying positions, which includes:- Competitive base pay
- Matching retirement programs
- Health, Dental and Vision plans
- Health Savings and Flexible Spending Accounts
- Employee discounts including car rental, cell-phone plans
- Employer-paid, Long-Term Disability, Life, and AD&D
- Paid time off (PTO)
- Education Assistance Program
- Employee Assistance Program
- Employee Referral Bonus Program
- Discounted cafeteria meals
- Paid Parental Leave
- Employee Service Recognition program
- Voluntary plans including: Life, AD&D, Short-Term Disability, Critical Illness, Accident, Insurance, and Hospital Indemnity
