Utilization Review RN - Acute Care & Authorization

Lexington Health, Inc.; Columbia (SC); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Day ONE medical, dental and life保险

403(b) match plan day one

Employer paid life insurance

Adoption assistance

Disability coverage after 90 days

Student loan forgiveness

Job summary

Lexington Health, Inc. seeks an experienced RN to perform admission and concurrent stay medical record review, determining appropriateness of admission and setting.

You will collaborate with physicians and care teams, secure third-party authorization, and support through throughput and discharge planning while ensuring regulatory compliance. Qualified candidates will have an ADN, Diploma, or BSN with acute care experience and be adept at communicating with payors and using InterQual criteria

Qualifications

• Minimum Education: ADN, Diploma Nursing Degree, or BSN.
• Three or more years of acute care hospital experience preferred.

Responsibilities

• Applies condition codes and modifiers in electronic medical record system for billing.
• Documents denial information and communicates with payors for appeals.
• Coordinates discharge planning and coordinates with Physician Advisor on documentation and authorization.

Skills

Communication skills

Teamwork

Critical thinking

Education

ADN

Diploma Nursing Degree

BSN

Tools

InterQual criteria

EMR system

Job description

Lexington Health, Inc. seeks an experienced RN to perform admission and concurrent stay medical record review, determining appropriateness of admission and setting.

You will collaborate with physicians and care teams, secure third-party authorization, and support through throughput and discharge planning while ensuring regulatory compliance. Qualified candidates will have an ADN, Diploma, or BSN with acute care experience and be adept at communicating with payors and using InterQual criteria