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Utilization Review RN
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- As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team.
- The goal of care coordination is to assist in managing care, cost, and outcomes across the continuum of patient care as it relates to acute inpatient stay and post-acute facility stay.
- The Utilization Review RN Coordinates continuing care/outside services for value based risk members (HMO members) in collaboration with the hospital and primary care physician.
- Collaborates with the health care team for quality improvement (primary care physician, social workers, pharmacists, home visit providers, care coordination support staff).
- Working knowledge of Medicare guidelines as it relates to length of stay, covered bed days, issuing denial notices, working with Livanta, issuing DENCs and NOMNCs∯*∯ - Responsible to create initial profile on all admitted patients, acute, SNF, LTAC, OON providing description of the reason for admission and providing evidence by using InterQual that the admission was appropriate.
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