RN Utilization Review

ID: Shift: Day 5x8-Hour (08:30 - 17:00) Description: Shift: 5x8 hour daysYears of Experience: 2 preferredUnit accepts first time travelersThe Case Manager is responsible for medical necessity review discharge planning and utilization review. Identifies and communicates changes in the patients plan of care to the health care team. Maintains detailed knowledge of community resources and process for referrals Using LOS anticipates patient needs stewardship of resources and timely transitioning of patients to alternative level of care Documents in patient record in a consistent and timely manner to include initial screenings and discharge plan.100-mile radius rule no local candidates Modified Time:7/27/2026 12:00:00 AM Account Manager: Rachel Holliday Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Submittals:Low Job Requirements & Qualifications Previous Charge Experience : Preferred Years of Experience : 2 Patient Ratio Experience : Charting System Experience : Required Charting System Name : Epic Community Hospital Experience : Preferred LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : - Certifications : BLSSkills : Acute Hospital Admission Criteria Admission Criteria Appeals and Denials* Appeals and Denials* Audits* Benefits Eligibility* Care coordination CMS: Centers for Medicare and Medicaid Services Concurrent Review* Continued Stay Reviews* Continued Stay Reviews Determine Medical Necessity per Evidence-Based Guidelines* Discharge Planning DRG (Diagnosis Related Groups)* HIPAA guidelines (Health Insurance Portability and Accountability Act) ICU* Medical Necessity MS* Needs Assessment/ Order DME Plan of Care Unit Details Staffing & Scheduling Scheduling Type : - Patient Ratios Days : 20 Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : - Number of Weekend Shifts Per Contract : - Pre-Approved Time Off : - Orientation Hours : 24 Facility & Patient Care Details Patient Age Groups : Adults Pediatrics Geriatrics Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : - Special Procedures/Unit Details : - Special Equipment : - #Tier2 Travel Compliance Ardent Submission Rules : 100-mile radius rule no local candidates State or Compact license must be in hand at time of submittal All RTO must be listed at time of submittal Previous Staff must wait 1 year before returning as a traveler Compliance Rules : Onboarding : Must complete core items/labs within 48 hours of contract signing Modules: Modules are non-billable all hours are factored in NBO RN average 4-6 hours Allied 2-3 hours Modules are completed onsite during orientation Submittal Details: #Tier2 Travel ComplianceArdent Submission Rules:100-mile radius rule no local candidatesState or Compact license must be in hand at time of submittalAll RTOmust be listed at time of submittalPrevious Staff must wait 1 year before returning as a travelerCompliance Rules:Onboarding: Must complete core items/labs within48 hoursof contract signingModules:Modules are non-billable all hours are factored in NBORN average 4-6 hoursAllied 2-3 hoursModules are completed onsite during orientation Guaranteed Hours: Contract Weeks:91