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Registered Nurse - Utilization Management
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$40
Part-time
- Partners with the health care team to ensure hospital admissions are based on medical necessity and documentation is sufficient to support the level of care being billed.
- Works collaboratively with ICM service lines to expedite patient discharge.
- Screens physician documentation or order entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care, medical necessity, and third-party payer requirement.
- Utilizes other application tools to document including Veracity, Optum, InterQual, Milliman, etc.
- Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer certification, and denied cases.
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