Utilization Review Nurse 6541
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Job Location:
West Lafayette - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Text 6541 to to Quick Apply for this Utilization Review Nurse opportunity!
Welcome Bonus $2500!
Your dedication our commitment
If you are a passionate dedicated professional that wants to make a difference in our patients lives then please consider the following open position:
Meridian Health Services at River Bend is currently seeking a full time Utilization Review Nurse for our Inpatient Program located in Lafayette Indiana. This is a great opportunity to make an impact in the lives of others.
Utilization Review Nurse Key Responsibilities:
- Screens all admissions for appropriateness according to criteria development by U.R. Committee and based on admission diagnosis and as-signs length of stay (LOS).
- Review each case daily after admission to adjust LOS if diagnosis has been changed.
- Review each case 2 days before assigned LOS expires to determine presence/absence of need for continued stay.
- Reviews all observation status patients with physician regarding continued treatment within 24 hours.
- Enters UR note service on each patient for precertification concurrent retro-active and other notes as needed.
- Scans/attaches facsimile confirmations authorization letters 1261As and other documents as needed to appropriate service.
- Monitors all pending and current patient insurance status.
- Calls providers to obtain prior authorization status within 24 hours of admission.
- Complete concurrent reviews with providers as necessary.
- Refers any unclear cases to the Medical Director.
- Refers appropriate cases to U.R. Committee.
- Completes all appeals for denial authorization(s) as needed. (Refers for peer to peer or writes letter of intent to appeal with clinical support requesting authorization)
- Maintains an ongoing summary of all in-hospital Medicare patients.
- Ensures all Medicare recertification are completed by the Attending Physician on day 12 day 30 and every 30 days thereafter.
- Consults with physicians and treatment team re: continuation of treatment and insurance coverage.
- Works with billing office representative to ensure accurate authorizations for claims and retro-active stay coverage.
- Refers uninsured patients to Entitlement Specialist for appointment.
- Ensures patient has met with Entitlement Specialist if needed.
- Discontinues coverage according to Medicare guidelines.
- Issues written notices of disapproved continued hospital stay to appropriate cases.
- Performs liaison work as needed with Indiana medical Review Organization and commercial insurance.
- Serves on UR committee and prepares documents as needed to report to committee.
- Prepares weekly spreadsheet for Revenue Cycle Meeting.
- Keeps spreadsheet of needed retro-active authorization with current status.
- Enters authorization numbers and dates into patient file.
- Provides unit nursing coverage as needed. (may work up to a 12-hour shift as needed)
- Provides nurse on call coverage as needed.
- Participates in Hospital quality improvement program.
- Attends or completes all mandatory nursing requirements as available including staff/nursing meetings.
We are seeking Utilization Review Nurse candidates with the following qualities:
- Graduate of an accredited School of Nursing.
- Non-probationary Licensed as a Registered Nurse by the State of Indiana Health Professions Bureau.
- Previous inpatient psychiatric nursing experience desirable.
- Meets pre-hire competency and reference requirements.
- Holds a valid Indiana Drivers License has a reliable vehicle a good driving record and insurance.
Meridian Health Services provides the following benefits for our Utilization Review Nurses:
- Health dental vision plans
- $2500 Welcome Bonus
- Merit Based Compensation Plans
- 401k with company contribution
- Voluntary benefits including critical illness short term disability etc.
- Generous PTO plan
- Wellness plan
- Professional development funds
- Life balance-oriented organization
Drug screen TB test extensive background check and fingerprinting are required of all Meridian employees. Meridian Health Services recommends that all individuals who join Meridian have a flu shot and Covid vaccination to further protect our staff and the patients we serve. We also adhere to Covid-related protocol including wearing masks social distancing and sanitizing.
Meridian Health Services is an Equal Opportunity Employer (M/F/D/V) and also participates in E-Verify.
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Dermal Fillers
- Experience Administering Injections
- Home Care
- Nursing
- Botox Experience
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
Meridian Health Services believes in treating the “whole-person” integrating physical, mental and social well-being to help people achieve their optimum health.
