RN Utilization Review - Patient & Family Services - Per Diem
About the role
Southern NH Medical Centers strives to keep patients on a continuous track to discharge and receive the continuity of care that our patients and their families need. Our Patient and Family Services Department is the driving force to assure communication, respect, and safety follows our patients throughout the admission phase, all the way through the discharge process. This department includes a dedicated team of Case Managers, Social Workers, and Interpreters that ensure that all care is equal, and our patient's dignity is maintained above all else.
Responsibilities
- Assess acute medical necessity utilizing appropriate criteria.
- Collect and trend Utilization Review data metrics.
- Review appeal options for commercial insurance, RAC, and QIO medical necessity denials.
- Understand and apply CMS Regulations to meet compliance.
Requirements
- Current NH Nursing License as a Registered Nurse.
- ASN accepted; BSN required within 10 years of hire.
- A minimum of 5-years' of experience as a Registered Nurse.
- Experience in use of Interqual, Milliman or other Healthcare acute criteria preferred.
Qualifications
None specified.
Skills
None specified.
Benefits
Health, dental, prescription, and vision coverage for full-time & part-time employees
Short-term, long-term disability, life & pet insurance
Student Loan Forgiveness & Discounts
403(b) Retirement savings plans
Continuous earned time accrual & So much more!
Pay
TBD
Schedule
TBD