RN Utilization Review
Location: Sioux Falls, South Dakota
Description: Avera Health is presently looking of RN Utilization Review right now, this position will be located in South Dakota. For detail informations about this position opportunity kindly read the description below. The Utilization Review RN reviews current admissions, stays that go beyond the approved days and retrospective inpatient and observation cases to determine accurate level of care determination based on primary and/or secondary insurance payment requirements. The position also reviews scheduled/booked surgical cases and compares the scheduled registration status with any inpatient only procedure lists for specific insurance companies and ensures registration status is changed based on insurance payment rules; they also obtain a signed inpatient order is on the account for all Medicare inpatient only procedure cases. The position collaborates with clinicians and financial team members including the Pre-anesthesia Department, Surgery Scheduling, Clinical Departments, physicians, payers, Patient Access, Health Information Management, and Case Management. Demonstrates a willingness to maintain awareness of the business of medicine and transitional healthcare changes including but not limited to value-based purchasing ,bundled payments, accountable care organizations and the readmission reduction program.
EDUCATION and/or EXPERIENCE:
- Graduate from a CCNE or NLN accredited nursing program is strongly preferred. Graduate from an approved nursing program is acceptable.
- Bachelor's degree in nursing preferred.
- Four years related clinical experience and/or training preferred. Knowledge of hospital revenue cycle and the electronic health record strongly preferred.
- Minimum 1-3 years of related professional experience.
- Licensed as a Registered Nurse in the State of South Dakota and/or meeting the requirements of Multi-state licensure is required.
- Professional certification preferred.
- Membership in a professional organization preferred.
- .
If you were eligible to this position, please send us your resume, with salary requirements and a resume to Avera Health.
Interested on this position, just click on the Apply button, you will be redirected to the official website
Apply RN Utilization Review Here
This position will be started on: Mon, 22 Jan 2018 21:42:22 GMT