RN Utilization Rvw Spclst - Utilization Management

Kettering Health Network; Miamisburg (OH); On-site; USD 34,440 - 48,216; Part time

Job summary

Kettering Health is seeking an experienced Utilization Management RN in Miamisburg, Ohio for a part-time, varied shift. Responsibilities include reviewing inpatient and observation admissions to ensure correct Admit status, and resolving medical necessity discrepancies with physicians and hospital leadership.

The ideal candidate holds an Ohio RN license (BSN preferred), has experience with computers, and is familiar with EPIC software.

Qualifications

• Current unrestricted Ohio RN licensure, BSN required.
• Experience with computers required.
• Part-time weekend shift; weekend-only schedule.

Responsibilities

• Review inpatient and observation admissions to ensure correct Admit status.
• Communicate with physicians and hospital leadership to resolve medical necessity discrepancies.
• Complete clinical review on all assigned patients and communicate reviews to payers.
• Identify potential or actual denials for admission or ongoing stay.
• Review and decide validity of medical necessity payer denials; submit payer denial appeals.
• Participate in design of workflows and procedures to reduce denials.

Skills

Computers

Communication

Education

Ohio RN licensure (unrestricted)

BSN

Tools

EPIC software

Microsoft Office

Job description

Job Details

Utilization Management | Miamisburg | Part-time | Varied Shift

Responsibilities & Requirements

• Registered professional nurse with education, knowledge and experience.
• Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status.
• Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.
• Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.
• Identifies potential or actual denials for admission or ongoing stay both during the patient’s hospital stay and post discharge.
• Review and decide the validity of medical necessity payer denials. Submits payer denial appeals.
• Participates in design of work flows and procedure to reduce incidence of denials.
• Current unrestricted Ohio RN licensure, BSN required.
• Experience with computers required.

Preferred Qualifications

• 5 years clinical experience with 2 years case management
• Case Management certification
• Works independently
• Familiar with MCG Care guidelines
• Ability to adapt quickly to changing priorities and regulations
• Experience with Microsoft applications and EPIC software

! WEEKEND ONLY!

Overview

Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.