Minimum Hiring Wage:From $90,064.00 a year
Job Details:Scheduled Hours: 8:00am - 4:30pm | Every 6th Weekend 8:00am - 8:00pm
Job Description: Associate's Degree (AA) Nursing Required - 4-6 years Require 4-6 years clinical experience Required
- 1-3 years Previous experience in Utilization Review Required
- Registered Nurse Iowa Board of Nursing (IBON) (United States of America) Required
- Bachelor's Degree in Arts/Sciences (BA/BS) Nursing Preferred
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. The Utilization Review Team lead function as a Utilization Review Specialist. In addition, the Utilization Team lead will be responsible in completing and following up on inpatient denials. The team lead will lead daily huddles and act as a resource to the Utilization Review team.
Qualifications: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
- Respond to and assist the revenue cycle in claim correction. Submit appeals of denied claims. Follow up on appeals until there is resolution
- Lead the Utilization Review team in their daily tasks and daily huddles
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
