Inpatient Utilization Review Registered Nurse PRN RN
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Job Location:
Atlanta, GA - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Overview
Be inspired. Be rewarded. Belong. At Emory Healthcare.
At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorship and leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
- Comprehensive health benefits that start day 1
- Student Loan Repayment Assistance & Reimbursement Programs
- Family-focused benefits
- Wellness incentives
- Ongoing mentorship development leadership programs and... more!
Description
The UR RN (PRN) will perform utilization review by completing a timely and comprehensive review of all new observation and inpatient admissions for status designation as guided by criteria guidelines patient presentation and clinical nursing addition concurrent reviews will be completed as required by the payers by accurately applying appropriate criteria sets.
The UR RN (PRN) will ensure that all reviews are completed timely accurately and thoroughly by ensuring criteria guidelines applied are addressed in the clinical review. The UR RN (PRN) is responsible for timely communication to the Physicians and Interdisciplinary team as it relates to criteria guidelines and status designation on an individual patient basis. The UR RN (PRN) will ensure that patient hospital days are appropriately reviewed in order to obtain the appropriate authorization from the payer in an effort to ensure appropriate payment for services provided. The UR RN (PRN) will ensure that authorized days and patient actual LOS are reconciled in order to maximize reimbursement for the services provided.
The UR RN (PRN) is responsible for real time communication and documentation of authorized unauthorized or denied days to the Physician and the care team in order to reduce patient and hospital financial risk. The UR RN (PRN) will initiate and facilitate RN to RN discussion and/or Physician to Physician discussion with the payers in order to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered non-authorized or denied services. The UR RN (PRN) will issue and administer notices of non-coverage and potential liability to patients in accordance with predetermined regulations policies and procedures. The UR RN (PRN) attends interdisciplinary care planning rounds and serves as a liaison between the clinical care team the revenue cycle and the patient to ensure the continuity of patient care. The UR RN (PRN) serves as a resource to the Physician Interdisciplinary Care Team and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to the utilization review process.
The UR RN will (PRN) ensure compliance with all regulatory requirements as it relates to Government and Commercial Payers and designated Utilization Review Plans as submitted to the State of Georgia. The UR RN (PRN) will ensure compliance with all third party payers and federal and state regulatory agencies. The UR RN (PRN) will ensure proper use of Case Management Systems and workflows.
MINIMUM QUALIFICATIONS: Must have a valid active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board. Bachelors degree in nursing preferred or actively being pursued. 2 years recent healthcare experience required. Must meet all quality and productivity expectations and successfully complete yearly competencies. Must be willing to work at least 4 shifts/mo.
PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs 0-33% of the work day (occasionally); 11-25 lbs 34-66% of the workday (frequently); 01-10 lbs 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking Occasional sitting Close eye work (computers typing reading writing) Physical demands may vary depending on assigned work area and work tasks.
ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock Floor Surfaces Hot/Cold Temperatures Indoor/Outdoor conditions Latex Lighting Patient care/handling injuries Radiation Shift work Travel may be required. Use of personal protective equipment including respirators environmental conditions may vary depending on assigned work area and work tasks.
Additional Details
Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.
Required Experience:
IC
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
"Have a Coke and a smile" means more to Emory University than it does to the rest of the world. The school, which has some 13,300 students and about 12,500 staff and faculty members, has a very low student-teacher ratio of about 7:1. It changed from Emory College to Emory University i ... View more
