Behavioral Health Utilization Review RN

McLaren Health Care; Bay City (MI); In loco; USD 70.000 - 90.000; Tempo pieno

Descrizione del lavoro

McLaren Health Care is seeking an UR Specialist RN to work with admitting physicians and the care team to determine admission status based on payer requirements and medical necessity. You will perform concurrent reviews, monitor hospital resources, and help ensure reimbursement is supported by documentation.

The role requires an active Michigan RN license and a nursing degree, with 2 years of clinical or utilization management experience. On-site hours are 7:00am–3:00pm, with no on-call duties.

Competenze

• Requires Nursing degree from an accredited institution.
• Michigan RN license is required.
• Two years of recent clinical or utilization management experience.

Mansioni

• Performs concurrent and retrospective utilization management reviews to ensure data is tracked, evaluated and reported.
• Collaborates with health care team to determine inpatient vs. outpatient setting based on medical necessity.
• Works with case management to expedite patient discharge and optimize hospital reimbursement.

Conoscenze

Clinical documentation

Healthcare compliance

Collaboration

Formazione

Nursing degree from an accredited institution

State of Michigan RN license

Strumenti

Electronic Medical Records

Descrizione del lavoro

McLaren Health Care is seeking an UR Specialist RN to work with admitting physicians and the care team to determine admission status based on payer requirements and medical necessity. You will perform concurrent reviews, monitor hospital resources, and help ensure reimbursement is supported by documentation.

The role requires an active Michigan RN license and a nursing degree, with 2 years of clinical or utilization management experience. On-site hours are 7:00am–3:00pm, with no on-call duties.