RN-Utilization Review

Responsibilities

• Utilization Review
• Discharge Planning
• Readmission Reduction Participation
• Payer Communication and Denial Reduction
• Completes Assigned Goals

Specifications

• Experience: Minimum Required - RN with at least one (1) year of clinical experience
• Preferred/Desired - RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
• Education: Minimum Required - Diploma or Associate Degree in Nursing
• Preferred/Desired - BSN or MSN
• Training: Preferred/Desired
• Licensure: Minimum Required - RN

Special Specifications

• Experience: Minimum Required - Certified Case Manager
• Knowledge: Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
• Skills: Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.