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Registered Nurse Utilization Review OPIS
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Full-time
- NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
- JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk.
- Serves as a liaison between hospital and payer to obtain pre-authorization confirmation and enters into medical record/billing system timely and accurately.
- Communicates with physicians to ensure that correct clinical data is documented to gain proper pre-authorization for third party payers.
- Makes referrals to the Case Manager of compassion drug program as appropriate.
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