Per Diem Utilization Review RN - Chart Review

Carson Valley Health; Gardnerville, Northern (NV, KY); Hybrid; USD 5,510,000 - 9,643,000; Full time

Job summary

Carson Valley Health in Nevada seeks a Per Diem Utilization Review RN to perform clinically oriented medical chart reviews and support the hospital's utilization review plan, ensuring medical necessity and proper documentation.

Requirements include Nevada RN licensure, at least 1 year in case management/UR, CCM preferred, and knowledge of InterQual/McKesson criteria. Per diem status adds 15% to the hourly rate.

Qualifications

• Must be licensed as a Registered Nurse by the State of Nevada.
• Minimum of 1 year of case management or utilization management experience.
• CCM (certification in case management) is preferred.
• Knowledge of InterQual or McKesson criteria preferred.
• Knowledge in conducting a medical record review for medical necessity.

Responsibilities

• Chart Review: conduct chart reviews to determine InterQual-based care criteria is met; assist in determining if patients are in the correct hospital setting; review elective surgery schedule; review outpatient charts (observation).
• Hospital Reimbursements: understand requirements to maximize reimbursement; obtain authorizations; respond to insurance providers; coordinate with hospital departments; review denials and assist in appeals.
• Documentation: locate priority clinical information; interpret information for treatment; collaborate with coding staff to ensure accurate discharge diagnoses and comorbidities; support clinical documentation improvement strategies.

Skills

RN license NV

UR experience

InterQual knowledge

CCM preferred

Education

Bachelor's in Nursing

Job description

Carson Valley Health in Nevada seeks a Per Diem Utilization Review RN to perform clinically oriented medical chart reviews and support the hospital's utilization review plan, ensuring medical necessity and proper documentation.

Requirements include Nevada RN licensure, at least 1 year in case management/UR, CCM preferred, and knowledge of InterQual/McKesson criteria. Per diem status adds 15% to the hourly rate.