Registered Nurse - Utilization Review Coord - Psychiatric Medical Unit

Trinity Health; Grand Rapids (MI); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Remote work

Job summary

Trinity Health is seeking a Night Shift RN Utilization Review in Grand Rapids, MI, offering full-time work with remote options. You will review assigned cases against criteria and payor guidelines to ensure proper reimbursement and medical necessity for acute care hospitalization.

In collaboration with the health care team, you will conduct observation, admission, concurrent, discharge, and retrospective reviews to evaluate level of care and discharge planning, and you will provide consultation

Qualifications

• Bachelor of Science in Nursing (BSN) required.
• Current State of Michigan Registered Nurse License.
• Three years acute care as an RN.
• Preferred: Two years acute care utilization management experience; facility audits and processes.

Responsibilities

• Perform all aspects of utilization review to ensure medical necessity with supportive documentation in the EMR.
• Provide external review organizations the information necessary to complete reviews and maximize reimbursement.
• Collaborate with Case Management.
• Provide consultation and information to physicians, case managers and other health care team members.

Education

BSN

Job description

Employment Type:Full timeShift:Night ShiftDescription:

Position Summary:

Reviews assigned cases applying specific criteria and payor guidelines and communicates this review to payors
ensuring proper reimbursement for care. In collaboration with members of the health care team, conducts
observation, admission, concurrent, discharge and retrospective reviews to evaluate the appropriate level of care,
continued stay, and status of discharge planning.

What you will work:

• Full time
• 40 hours per week
• 11:00 PM - 7:30 AM
• Remote
  

What you will do:

• Perform all aspects of utilization review to ensure the medical necessity of acute care hospitalization has the existence of supportive documentation in the EMR
• Provide all external review organizations the information necessary to complete reviews and effect maximum financial reimbursement
• Collaborate with Case Management
• Provides consultation and information to physicians, case managers and other members of the health care team
  

What you will need:

• Bachelor of Science in Nursing (BSN)
• Current State of Michigan Registered Nurse License
• Three years acute care as a RN
• Preferred: Two years recent acute care utilization management experience, experience in facility audits/appears and processes
• Ability to work autonomously with little direction and be accountable for outcomes
  

What you will work:

• Full time
• 40 hours per week
• Night shift

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.