RN Utilization Review - Care Coordination & Payer Liaison

Catholic Health; Buffalo (NY); On-site; USD 90,000 - 110,000; Full time

Job summary

Sisters of Charity Hospital in Buffalo, NY is seeking a Registered Nurse (RN) for Utilization Review to join the Middle Revenue Cycle and care team. You will perform comprehensive utilization review to facilitate patient movement and maintain payer relationships.

Responsibilities include concurrent review, inquiries, and coordination with third-party payers. A strong knowledge of state/federal contracts and UR processes is essential for success in this role.

Qualifications

• BSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting
• Unrestricted NYS RN license
• Holds, or will obtain within one year of hire, CCM
• Certification in a Nationally Recognized Utilization Review Criteria set is preferred
• At least one year of experience working with third party payers strongly preferred

Skills

Clinical assessment

Communication

Team collaboration

Technology familiarity

Decision making

Education

BSN degree

RN license

CCM certification within 1 year

UR criteria certification (preferred)

Tools

Clinical documentation systems

Job description

Sisters of Charity Hospital in Buffalo, NY is seeking a Registered Nurse (RN) for Utilization Review to join the Middle Revenue Cycle and care team. You will perform comprehensive utilization review to facilitate patient movement and maintain payer relationships.

Responsibilities include concurrent review, inquiries, and coordination with third-party payers. A strong knowledge of state/federal contracts and UR processes is essential for success in this role.