RN Utilization Review / Utilization Review / Per Diem

Wood County Hospital

Bowling Green (OH)

On-site

USD 60,000 - 90,000

Part time

14 days+

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Benefits offered by this job

Great health, dental and vision plans

Competitive wages

Flexible spending accounts

Generous tuition reimbursement

401(k) with employer match

Paid vacation and holidays

Job summary

A regional healthcare provider in Bowling Green, Ohio, is seeking an RN for Utilization Review on a per diem basis. This role involves reviewing patient records for medical necessity, collaborating with healthcare teams, and ensuring adherence to clinical guidelines. A Bachelor's degree in Nursing is preferred along with a valid Ohio nursing license and a minimum of three years in acute care. Benefits include competitive wages, health plans, and generous tuition reimbursement.

Qualifications

Graduate of an accredited nursing program required.
Current licensure to practice professional nursing in Ohio.
Minimum of three years acute care nursing experience required.
Minimum of three years acute care nursing experience.

Responsibilities

Review patient records for medical necessity and authorization denials.
Serve as a resource for standards of care in utilization review.
Develop and enforce compliance policies for regulatory agencies.
Analyze patient records to determine admission legitimacy.
Monitor appropriate utilization of resources using clinical criteria.

Skills

Clinical decision-making

Interdisciplinary collaboration

Regulatory compliance

Utilization review knowledge

Education

Bachelor's degree in Nursing (BSN)

Ohio nursing license

Job description

Elevate your career at Wood County Hospital, where you're not just a number – you're a vital part of a team making a real difference.

RN Utilization Review / Utilization Review / Per Diem

Reviews patient records for medical necessity, level of care, length of stay, and authorization denials for inpatients and observation patients. Assists in the clinical appeal process. Collaborates with the healthcare team to coordinate care according to evidence-based, approved guidelines (e.g. Milliman Care Guidelines, Interqual).

Major Tasks, Duties and Responsibilities

Serves as a resource for current standards of care, related to utilization review and case management.
Participates in interdisciplinary collaboration.
Aids with clinical decisions related to patient plans of care.
Develops and enforces policies and procedures for the hospital related to compliance with regulatory and accreditation agencies, and other county, state, and federal agencies.
Utilizes applicable criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning (e.g. Milliman Care Guidelines, Interqual).
Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in hospital to comply with government and insurance company guidelines.
Monitors and makes recommendations for appropriate utilization of resources using evidence-based clinical criteria.
Other duties as assigned.

Education, Training and Experience

Graduate of an accredited program for nursing education, Bachelor’s degree in Nursing (BSN) preferred.
Current licensure to practice professional Nursing in the State of Ohio.
Current American Heart Association (AHA) Healthcare Provider CPS (BLS) certification required.
Minimum of three years acute care nursing experience required.

Benefit Summary

Join our team, and you’ll have access to a cutting-edge facility with state of the art technology. You’ll also interact with some of the region's top notch healthcare professionals. You’ll find plenty of opportunities to grow and advance your career.

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