RN-Status Review Specialist

Job Responsibilities and Requirements

• Reviews electronic medical record and screens clinical information with nationally recognized criteria.
• Communicates with physicians regarding patient admission status.
• Reviews Medicare beneficiary short stay hospital admissions.
• Collaborates with attending physician and case managers regarding Condition Code 44 accounts.
• Reviews inpatient admissions changed to outpatient for possible Condition Code 44 criteria.
• Identifies and escalates barriers/gaps to leader of department.
• Participates with other members of team regarding opportunities for improvement in standard work.
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
• Performs other duties as assigned.

Education and Experience

• Graduate of accredited school of nursing or education equivalency for licensing.
• Two years' acute care experience.

Physical Requirements

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication.
• Able to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Rare climbing.

Professional License and/or Certifications

• State of Work Location: Illinois - Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
• State of Work Location: Missouri - Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration
• State of Work Location: Oklahoma - Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
• State of Work Location: Wisconsin - Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Work Shift

• Day Shift (United States of America)

Benefits

• Paid Parental Leave: one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
• Upfront Tuition Coverage: provides upfront tuition coverage through FlexPath Funded for eligible team members.

Schedule

• Standard Business Hours: M-F 7:30am-4pm.

Qualifications

Highly Preferred: Prior Utilization Management (UM) experience and knowledge of EPIC.