RN Utilization Rvw Spclst - Utilization Management

Kettering Health; Miamisburg (OH); On-site; USD 55,104 - 68,880; Part time

Job summary

Kettering Health is seeking a Registered Nurse for Utilization Management in Miamisburg on a part-time, weekend-only schedule. The role centers on reviewing inpatient and observation admissions to ensure proper Admit status and communicating with physicians and leadership to resolve medical necessity discrepancies.

Ideal candidates have a BSN, Ohio RN licensure, and the ability to analyze payer denials, with experience in EPIC and Microsoft Office.

Qualifications

• Current unrestricted Ohio RN licensure, BSN required.
• Experience with computers required.

Responsibilities

• Review inpatient and observation admissions to ensure correct Admit status.
• Communicate with physicians and hospital leadership to resolve medical necessity discrepancies.

Skills

Case management

Independent worker

Adapt to change

Communication

Education

BSN

Ohio RN licensure

Tools

EPIC

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.