Utilization Review RN

The UR RN Case Manager facilitates effective utilization of appropriate health services via collaboration with physicians, nurses, social workers, other healthcare team members (ie – financial counselors), and payers to coordinate health care services that optimize clinical outcomes and patient satisfaction with services from pre-admission through post-discharge transition for this select patient population for all portals of entry. This position performs pre-admission, concurrent admission, and retrospective clinical review of medical necessity to determine the appropriate level of care and resource utilization. The UR RN Case Manager is responsible for ensuring implementation and monitoring of compliant documentation strategies by ensuring procedure(s) noted in the pre-admission review was/were completed and the physician’s orders are present, accurate, and signed before patient being discharged; or updated as needed once the operative note has been reviewed.

Benefits:

Health, Vision, and Dental. 

HSA or HSA 

Life insurance

401K

PTO and Sick leave

Employee referral program

Licenses and Certifications Required:

Current or temporary RN license in ND or compact RN licensure. BLS certification is required within the orientation period.

Educational Requirements:

BSN preferred.

Experience Requirements:

Must have three (3) years of recent experience in a clinical area. Prior Case Management/Utilization Review experience preferred.

Special Skills or Training Requirements:

Demonstrated evidence of dependability, diplomacy, and initiative. Demonstrated strong communication and interpersonal skills with all levels of internal and external customers, including but not limited to medical staff, patients and families, clinical personnel, other Case Managers, support and technical staff, outside agencies, third party payers, and members of the community: Basic understanding of reimbursement issues, denials, and DRGs: Knowledge of clinical criteria for medical necessity: Personal computer skills using e-mail and Microsoft Office Suite.