Registered Nurse Utilization Review SCH

Facility: Sisters of Charity HospitalShift: Shift 1Status: Full Time FTE: 1.000000Bargaining Unit: ACE AssociatesExempt from Overtime: Exempt: YesWork Schedule: Days with Weekend and Holiday RotationHours: 8am -4 pmSummary:The Registered Nurse (RN), Utilization Review, as an active member of the Middle Revenue Cycle and interdisciplinary care team, provides comprehensive Utilization Review to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team to maintain appropriate levels of care and to facilitate movement of the patient through the continuum. The Utilization Review RN identifies and removes barriers for delays of treatment. This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization review process processes is vital.Responsibilities:EDUCATIONBSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting Unrestricted NYS RN license Holds, or will obtain within one year of hire, Certified Case Manager (CCM)Certification in a Nationally Recognized Utilization Review Criteria set is preferredAt least one (1) year of experience in working with third party payers strongly preferredExperienceMinimum of three (3) years of experience working in an Acute Care Hospital SettingProficiency in utilization management and regulatory requirements preferredExperience in working with people who are geographically dispersed preferredExperience in working with third party payers strongly preferredKNOWLEDGE, SKILL AND ABILITYStrong clinical assessment skills and ability to articulate findings in a fast-paced environment. Possess the ability to make independent decisions within the professional scope of practicePossess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approachPossesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and softwareExtensive knowledge of third-party payer guidelines, accreditation and regulatory requirements preferredKnowledge of Managed Care Organization contracts/agreements preferredWORKING CONDITIONSWillingness to work beyond normal working hours, and in other positions temporarily, and/or at other locations when necessaryVariable schedule which may include weekends and holidays. May be requested to travel to multiple hospital and community sitesENVIRONMENTNormal heat, light space, and safe working environment; typical of most office jobsOccasional exposure to one or more mildly unpleasant physical conditionsMinimum physical effort required, typical of most office workSignificant amount of walking within the acute care facility