Utilization Management RN- Weekender at Bryan Health

Job Description:

Latest job information from Bryan Health for the position of Utilization Management RN- Weekender. If the Utilization Management RN- Weekender vacancy in Lincoln matches your qualifications, please submit your latest application or CV directly through the updated Jobkos job portal.

Please note that applying for a job may not always be easy, as new candidates must meet certain qualifications and requirements set by the company. We hope the career opportunity at Bryan Health for the position of Utilization Management RN- Weekender below matches your qualifications.

Summary

GENERAL SUMMARY:

Conducts day-to-day activities for the clinical, financial and utilization coordination of the patients hospital experience. Proactively consults with the interdisciplinary team which includes, but is not limited to, hospital patient care staff, physicians, patient support and family to ensure the patients hospital stay meets medical necessity and insurance authorizations are obtained in order to facilitate the patients and hospitals financial well-being.

PRINCIPAL JOB FUNCTIONS:

1. Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. Performs utilization review activities, including concurrent and retrospective reviews as required.

3. Determines the medical necessity of request by performing first level reviews, using approved evidence based guidelines/criteria.

4. Collaborates with the patients provider and other healthcare team members in managing the patients length of stay and determining the continuing medical necessity of continued stays.

5. Refers cases to reviewing physician when the treatment request does not meet criteria per appropriate algorithm.

6. Participates in concurrent and retrospective denials and appeals process by researching issues surrounding the denial, participating in all levels of the appeal and process follow-up.

7. Serves as an internal and external resource regarding appropriate level of care; admission status/classification; Medicare/Medicaid rules, regulations, and policies; 3rd party and managed care contracts; discharge planning; and length of stay.

8. Ensures appropriate resource utilization relevant to the financial, regulatory and clinical aspects of care; proposes alternative treatment to ensure a cost effective and efficient plan of care.

9. Maintains awareness of financial reimbursement methodology, utilization management, payer/reimbursement practices and regulations and participates in resource stewardship.

10. Promotes quality improvement initiatives and health care outcomes based on currently accepted clinical practice guidelines and total quality improvement initiatives.

11. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

12. Participates in meetings, committees and department projects as assigned.

13. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk . Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Maintains clinical competency as required for the unit including but not limited to age-specific competencies relative to patients growth and developmental needs, annual skill competency verification and mandatory education and competencies.

2. Knowledge of governmental and third party payer regulations and requirements related to patient hospitalization and acute rehabilitation admission, stay and discharge activities, i.e., CMS, CARF, FIM (TM).

3. Knowledge of computer hardware equipment and software applications relevant to work functions.

4. Skill in conflict diffusion and resolution.

5. Ability to communicate effectively both verbally and in writing.

6. Ability to perform crucial conversations with desired outcomes.

7. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

8. Ability to problem solve and engage independent critical thinking skills.

9. Ability to maintain confidentiality relevant to sensitive information.

10. Ability to prioritize work demands and work with minimal supervision.

11. Ability to perform crucial conversations with desired outcomes.

12. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act. Minimum of two (2) years recent clinical experience required. Prior care coordination and/or utilization management experience preferred.

OTHER CREDENTIALS / CERTIFICATIONS:

Basic Life Support (CPR) certification required. Bryan Health recognizes American Heart Association (for healthcare professionals), American Red Cross (for healthcare professionals) and the Military Training Network.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Job Info:

• Company: Bryan Health
• Position: Utilization Management RN- Weekender
• Work Location: Lincoln
• Country: US

How to Submit an Application:

After reading and understanding the criteria and minimum qualification requirements explained in the job information Utilization Management RN- Weekender at the office Lincoln above, immediately complete the job application files such as a job application letter, CV, photocopy of diploma, transcript, and other supplements as explained above. Submit via the Next Page link below.