PA - Utilization Management RN - Days - TUH - 12498

Must have ability to follow up with insurances to obtain authorizations, follow up with denial activityOnsite Hours 8a-5pJob Description Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care. Requirements Education Other : Graduate of an accredited school of nursing (Required) Bachelors Degree : BSN (Required) Experience 1 Year experience of recent Utilization Review in acute care or in insurance company setting. (Required) 1 Year experience in medical-surgical setting. (Required) 1 Year experience in working with competency utilizing InterQual criteria. (Required) General Experience in working with utilization review standards. (Required) License/Certifications RN-LIC - PA Registered Nurse License (Required) CCM - Certified Case Manager (Preferred) _

Shift: Hours 8a-5p

Specialty Type: Nursing

Sub Specialties: Utilization Review RN

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