Utilization Review RN — Elevate Patient Care (PRN Day)

3M HEALTHCARE; Kansas City (MO); On-site; USD 65,000 - 90,000; Full time

Job summary

3M HEALTHCARE is seeking a Utilization Review RN to ensure high-quality, cost-efficient medical outcomes through utilization review and management. The role involves chart review, collaboration with physicians, care coordinators, social workers, and revenue cycle teams to optimize service levels and billing.

Responsibilities include performing initial and concurrent reviews using InterQual guidelines, obtaining authorizations, and addressing denials to minimize financial impact.

Qualifications

• Registered Nurse with less than 1 year of experience.
• Associate degree required.

Responsibilities

• Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using InterQual guidelines.
• Complies with CMS regulations regarding utilization review/management.
• Obtains and manages insurance authorizations and works denials to mitigate financial impact.
• Submits referrals for secondary level review and follows through on process.
• Documents communication and work in the electronic medical record.
• Collaborates with physicians and revenue cycle teams to ensure appropriate service level, care level and billing.

Education

Associate Degree

Job description

3M HEALTHCARE is seeking a Utilization Review RN to ensure high-quality, cost-efficient medical outcomes through utilization review and management. The role involves chart review, collaboration with physicians, care coordinators, social workers, and revenue cycle teams to optimize service levels and billing.

Responsibilities include performing initial and concurrent reviews using InterQual guidelines, obtaining authorizations, and addressing denials to minimize financial impact.