RN - Registered Nurse (19715)

JACKSON, MI, 49201

Date Posted: 01/29/2019


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REGISTERED NURSE (RN) - UTILIZATION REVIEW

Here at CareerStaff Unlimited we are looking for a registered nurse to work a 6 month contract at a hospital system in Detroit, MI. This position is an office envoirnemnt esk job utilizing a desk top computer. The hours are currently 9:00a-5:30 or 8:30a-5:00p.

GENERAL OVERVIEW:
Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification and education facilitates the quality of health care delivery in the most cost effective manner.
 
Experience with Interqual is highly desirable. Submits insurance claims to HAP, Moline, BCBS, and Meridian.

MAJOR RESPONSIBILITIES:
• Utilizes approved screening guidelines to evaluate the appropriateness of admission care, continuation of care and discharge screens.
• Serves as a principle link between Inpatient Case Management and third party payers, establishing relationships that positively impact financial outcomes.
• Identifies actual and potential problems throughout the hospitalization to improve the utilization of hospital resources through the appropriate action and/or recommendation. Analyze data as it pertains to the utilization of resources and quality and level of patient care.
• Reviews and provides medical information for those patients whose financial reimbursement to the hospital is dependent upon accurate information being provided to the appropriate government agencies and third party payers. Identifies inappropriate/inaccurate documentation that may potentially have legal and/or financial ramifications. Follows established guidelines for reporting issues.
• Facilitate/coordinate involvement of medical staff, when appropriate, in responding to third party payers requests’ to ensure positive outcomes and maximal reimbursement of hospital services.
• Communicates both written and verbally with third party payers to obtain necessary authorization for reimbursement of services. 
 
Qualifications:

• Registered Nurse with current MI license.
• Minimum of 3 years of Utilization review experience. Open to Case Managers with UR experience.
• Must have InterQual experience
• Ability to communicate with individuals from various socio-economic backgrounds regarding a variety of hospital wide practices.
• Knowledge of outside regulatory agencies that interface with hospital/healthcare.
• Previous medical insurance experience is preferred.

ABOUT CAREERSTAFF UNLIMITED:

CareerStaff Unlimited (CSU) is a leader in healthcare staffing, with a national network of 6 brands, operating 24 offices, serving over 1,650 clients, and employing over 4,350 clinicians. CSU attracts high quality clinicians who transition well to new environments, are knowledgeable of industry technology, and rapidly assimilate into facility teams. CSU services cover all types of medical personnel, including nurses, therapists and pharmacists. Our professional staffing team offers unrivaled customer service and industry commitment, unique opportunities, top pay, and benefits that meet the lifestyle requirements of our clinicians. With our local presence, CSU provides personalized support in each community while still benefiting from the national resources and assistance of our larger CSU network.

 

Brittany Merner –  Sr. Staffing Manager – Detroit, MI

CareerStaff Unlimited | A Genesis Healthcare Company

O: 248-203-0490 | F: 505-468-9477

Brittany.Merner@CareerStaff.com

www.careerstaff.com

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