RN Utilization Review, Weekend, Days

UofL Health; Louisville (KY); On-site; USD 70,000 - 90,000; Full time

Job summary

UofL Health is seeking an Utilization Review RN to support the Utilization Management process in a weekend day shift. You will review clinical data to determine medical necessity for admission and continuing stay, and apply payer guidelines to authorization decisions.

The role involves coordinating with care teams, documenting findings, and issuing notices related to admissions and continued reviews as required by insurance programs.

Qualifications

• Licensed RN responsible for Utilization Management processes.
• Interprets medical necessity for admission and continued stay.
• Screens patients for payer guidelines (insurance, Medicare/Medicaid).
• Issues payor-specific Notice of Admission and continued stay reviews.

Responsibilities

• Make clinical recommendations regarding medical necessity for admission and continued stay.
• Screen patients for client-specific payer guidelines.
• Send payor-specific Notice of Admission and continued stay reviews.

Skills

Utilization Review

Clinical decision making

Payer guideline interpretation

Job description

Primary Location:

250 E Liberty St

Address:

250 East Liberty St.Louisville, KY 40202

Shift:

Weekend Days (United States of America)

Job Description:

The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the delivery of the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.