Impactful Utilization Review RN - Hospital-Based Care

Trinity Health; Des Moines (IA); In loco; USD 70.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Full benefits package

Descrizione del lavoro

MercyOne Des Moines Medical Center is seeking an experienced Registered Nurse for Utilization Review. The role reviews admission status for inpatient and outpatient care, coordinates with physicians and Case Management, and ensures proper authorization and continued stay approvals using STAR and related systems.

The position requires Iowa RN licensure with 5+ years of clinical nursing. Day shift, full-time with opportunities for growth within MercyOne Health System’s care circle.

Competenze

• Current licensure as a registered nurse in the State of Iowa.
• Five years of clinical nursing experience.
• Bachelor of Science in Nursing or degree in healthcare-related field preferred.
• Proof of completion of Mandatory Reporter abuse training within three months of hire.
• Knowledge of eligibility requirements for insurance coverage and admission status criteria.

Mansioni

• Conduct admission review to ensure hospitalization is approved based on established criteria.
• Collaborate with attending physician and Case Management for status accuracy and approvals.
• Obtain insurance authorization and continued stay approvals; document interactions in STAR.
• Enter authorizations, approvals and denials into the STAR system and communicate changes to Case Management.
• Engage in discussions with physicians for status clarification and peer review as needed.
• Coordinate with Recovery Audit Contractor (RAC) and Conifer for denials management when applicable.

Conoscenze

Clinical nursing experience

Utilization review

Team collaboration

Communication

Formazione

BSN or healthcare-related degree preferred

Descrizione del lavoro

MercyOne Des Moines Medical Center is seeking an experienced Registered Nurse for Utilization Review. The role reviews admission status for inpatient and outpatient care, coordinates with physicians and Case Management, and ensures proper authorization and continued stay approvals using STAR and related systems.

The position requires Iowa RN licensure with 5+ years of clinical nursing. Day shift, full-time with opportunities for growth within MercyOne Health System’s care circle.