Utilization Review Nurse: Admission & Authorization Expert

Lexington Health; Columbia (SC); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Day ONE medical, dental and life

403(b) match plan day one

Employer paid life insurance

Tuition reimbursement

Job summary

Lexington Health is seeking a Registered Nurse to work in the Utilization Management Department. The role involves admission and concurrent stay medical record reviews, interfacing with attending physicians and third party payors to determine medical necessity and obtain authorizations.

You will support denial management and ensure documentation supports level of care throughout hospitalization. Minimum qualifications include an active SC RN license and at least 3 years of experience in an acute

Qualifications

• Minimum RN licensure in South Carolina.
• Minimum 3 years of experience in an acute care hospital setting.
• Substitutable Education & Experience: None.

Responsibilities

• Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting.
• Communicates with third party payors to obtain authorization and supports denial management.
• Reviews physician documentation and consults with physicians regarding completeness.
• Performs timely review of admissions utilizing InterQual criteria to assess appropriate level of care.

Education

ADN, Diploma Nursing Degree, or Bachelor of Science in Nursing

Job description

Lexington Health is seeking a Registered Nurse to work in the Utilization Management Department. The role involves admission and concurrent stay medical record reviews, interfacing with attending physicians and third party payors to determine medical necessity and obtain authorizations.

You will support denial management and ensure documentation supports level of care throughout hospitalization. Minimum qualifications include an active SC RN license and at least 3 years of experience in an acute