Utilization Review Nurse
Description
The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews with third party payors in order to obtain authorization, supports the revenue cycle. Acts as a liaison between third party payors and the treatment team. Collaborates with financial counseling and the revenue cycle team. Follows up on payor denials and initiates appeals. Provides consultation to treatment team members regarding payor requirements. Completes required documentation within the electronic health record. Adheres to current organizational performance improvement priorities and takes action to improve practices and policies.
JOB DUTIES
- Performs clinical reviews with third party payors in order to obtain authorization, supports the revenue cycle.
- Acts as a liaison between third party payors and the treatment team.
- Collaborates with financial counseling and the revenue cycle team.
- Follows up on payor denials and initiates appeals.
- Provides consultation to treatment team members regarding payor requirements.
- Completes required documentation within the electronic health record.
- Adheres to current organizational performance improvement priorities and takes action to improve practices and policies.
JOB QUALIFICATIONS
- Expertise, compassion, and kindness.
- Supports the patient experience.
- Builds an exceptional career with a health system that’s consistently ranked among the best in the country.
Salary Range
$74.16- $107.75
Awards & recognition
- Growth opportunity.
- Friendly and supportive work environment.
- Diverse and inclusive culture.