Utilization Review RN (Part-Time, Day Shift)

Trinity Health; Ann Arbor (MI); Presencial; USD 39.000 - 58.000; A tiempo parcial

Descripción de la vacante

Trinity Health in Ann Arbor, MI seeks a part-time Utilization Review Specialist who is a registered nurse. You will facilitate collection of patient information, apply clinical criteria, and communicate with external agencies. Weekend coverage is required on a rotating basis with occasional holidays, and shifts start between 6 a.m.

and 9 a.m. The role requires an accredited nursing degree with a BSN within five years, 2–3 years of related experience, and current Michigan RN licensure.

Formación

• Graduation from accredited nursing program; BSN required within 5 years.
• Two to three years related nursing experience with clinical knowledge.
• Current Registered Nurse license in Michigan (RN).

Responsabilidades

• Completes submission of utilization review documentation within established timelines.
• Identifies and resolves errors in patient demographics and insurance information.
• Submits utilization review documentation for payer reviews and documents outcomes.
• Communicates with case managers, physician advisors, and payer Medical Directors.
• Coordinates peer-to-peer concurrent appeal process and timely denials identification.
• Maintains positive working relationships with Care Management and Revenue Cycle teams.
• Documents assessments, interventions, and outcomes per standards and guidelines.

Conocimientos

Communication

Documentation

Care coordination

Collaboration

Educación

BSN within 5 years

RN license (MI)

Descripción del empleo

Trinity Health in Ann Arbor, MI seeks a part-time Utilization Review Specialist who is a registered nurse. You will facilitate collection of patient information, apply clinical criteria, and communicate with external agencies. Weekend coverage is required on a rotating basis with occasional holidays, and shifts start between 6 a.m.

and 9 a.m. The role requires an accredited nursing degree with a BSN within five years, 2–3 years of related experience, and current Michigan RN licensure.