Utilization Review RN — Shape Hospital Admissions

Prairie Lakes Healthcare System; Watertown (SD); Presencial; USD 58.000 - 93.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

Life insurance

403(b) plan

Paid time off

Flexible Spending Account

Employee Assistance Program

Education Loan Program

Community discounts

Descripción de la vacante

Prairie Lakes Healthcare System in Watertown, SD seeks a full-time Utilization Review Specialist to ensure medical necessity for hospital services and continued stay under Medicare and commercial payors.

This 0.9 status (36 hours per week) on-site role focuses on reviewing admissions within 24 hours, coordinating with physicians, and maintaining accurate documentation and reporting.

Candidates typically have five years of acute health care experience and nursing licensure in South Dakota.

Formación

• Five years of acute health care experience.
• Two years experience related to utilization review preferred.

Responsabilidades

• Develops and implements effective utilization review functions.
• Reviews inpatient and observation admissions within 24 hours for appropriateness.
• Contacts physicians to justify admission or continued stay.
• Refers cases for action after notifying Discharge Planning/Social Services manager.
• Develops and maintains a system to monitor and review certification completion.
• Maintains complete and accurate documentation reflecting status and denials.
• Reviews and follows through on the appeal process for denials.

Conocimientos

Utilization Review

Admissions review

Physician communication

Medical records

Educación

RN license (SD)

Descripción del empleo

Prairie Lakes Healthcare System in Watertown, SD seeks a full-time Utilization Review Specialist to ensure medical necessity for hospital services and continued stay under Medicare and commercial payors.

This 0.9 status (36 hours per week) on-site role focuses on reviewing admissions within 24 hours, coordinating with physicians, and maintaining accurate documentation and reporting.

Candidates typically have five years of acute health care experience and nursing licensure in South Dakota.