Utilization Review RN- Care Coordination- Full Time

Come work at the best place to give and receive care!

Job Description:

RN Utilization Review

Who We Are:

Elliot Health Systems Care Coordination Department located in Manchester NH plays a vital role in ensuring seamless patient-centered care across the healthcare continuum. Our team is dedicated to care management discharge planning and patient advocacy working closely with providers social workers and community resources to enhance patient outcomes. By developing individualized care plans facilitating smooth transitions between care settings and offering proactive support we help patients navigate complex healthcare needs while improving overall access to high-quality coordinated care.

About the Job:

Under the direction of the Director of Care Coordination the Utilization Review RN (UR RN) is responsible for ensuring the effective and efficient use of hospital services in alignment with the hospitals utilization review plan.

What Youll Do:

• Complete admission reviews to determine the appropriate level of care.
• Document continued stay reviews to assess the necessity of inpatient care procedures and estimated length of stay.
• Communicate and collaborate with payer care managers to prevent denials by ensuring timely clinical reviews.
• Address potential denials proactively working with physicians and payer representatives to minimize retrospective denials.
• Screen all patients upon admission or the next business day to determine appropriate level of care using medical necessity tools Medicare Inpatient Only List and payer requirements.
• Monitor observation status patients to ensure appropriate utilization and collaborate with admitting physicians if documentation does not support the current level of care.

• Perform concurrent reviews to justify extended stays working with attending physicians to ensure accurate documentation of medical necessity.

• Refer cases that do not meet admission or continued stay guidelines to the Utilization Review Physician Advisor after discussions with attending physicians.

Who You Are:

• Graduate of an accredited nursing program (Bachelors degree in Nursing required for nurses hired after May 2015 or commitment to obtain within a specified timeframe).
• Minimum of three (3) years of experience in hospital case management or utilization management.
• Active New Hampshire or Compact State RN license required.
• CCM or ACM certification preferred.

Why Youll Love Us:

• Health dental prescription and vision coverage for full-time & part-time employees
• Short-term long-term disability life & pet insurance
• Tuition reimbursement
• 403(b) Retirement savings plans
• Continuous earned time accrual

Work Shift:

SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation disability status veteran status or any other characteristic protected by law.