Employer Industry: Healthcare Provider

Why Consider this Job Opportunity:
- Competitive salary
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and outcomes
- Comprehensive benefits package, including medical, dental, and vision coverage
- Flexible work schedule options

What to Expect (Job Responsibilities):
- Perform utilization management assessments using evidence-based criteria and medical experience to determine medical necessity for hospitalized patients
- Collaborate with physicians to obtain additional documentation to support hospital medical necessity and discharge needs
- Escalate cases to the Utilization Review Manager and/or Physician Advisor as needed
- Document all actions and activities in the case management software system
- Review denials and coordinate peer-to-peer discussions with physicians, documenting results in the case management system
- Collaborate with Emergency Room Physician/staff to determine appropriate admissions and ensure medical necessity is clearly documented
- Communicate with UR Coordinator and facility case managers to ensure effective collaboration between all disciplines managing patient care

What is Required (Qualifications):
- Associates Degree in Nursing
- At least 3 years previous nursing experience
- Licensed Practical Nurse or Licensed Registered Nurse
- Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications
- Ability to perform physical demands outlined in the job description

How to Stand Out (Preferred Qualifications):
- 3 plus years Utilization review experience
- ACM or CCM Certification

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