Utilization Review RN-Full-Time - CodeForce : Job Details

Utilization Review experience is RequiredWork Schedule: Full TimeLocation: Community HospitalResponsibilities: Maintain and improve the case management system using ongoing interaction with patients, physicians, and other health providers to meet designated clinical, operational, and financial outcomes for aggregate patient populations. Assist physicians, patients, families, staff and payers in providing care for patient populations that is appropriate, effective, and cost efficient. Coordinates clinical review requests from payer sources to ensure timely reviews and ultimately timely payments to the hospital. Attend and actively participate in all departmental and interdepartmental meetings relative to Case Management/Social Services/Discharge Planning functions. EDUCATION and/or EXPERIENCE:Bachelor's Degree in nursing with at least three (3) years of clinical experience in a hospital setting, at least three (3) years of case management experience in a hospital setting, and at least two (2) years of Utilization Review experience with knowledge of evidence-based criteria guidelines OR equivalent combination of education and experience. CERTIFICATES/LICENSES:Current unrestricted Registered Nurse license in the State of Colorado (required) Case management certification (preferred) or will obtain within 1 year of employment Shift: Full-Time Specialty Type: Nursing Sub Specialties: Utilization Review RN Please CLICK HERE to view details.