Utilization Review - Registered Nurse (Weekend)
Mosaic Life Care · St Joseph, MO · 3 wk ago
HybridFull-time
We need to output HTML fragment with sections: h3 headings for sections present: About the role? The job description includes "Job Description" then description. We need to decide sections: maybe "About the role" (the description paragraph), "Responsibilities", "Education", "Work Experience", "Licenses and Certifications", "Travel Requirements", "Qualifications", "Skills and Abilities", "About Us". Also maybe "Benefits", "Pay", "Schedule" only if present. The posting mentions benefits in About Us: "Mosaic has a wide array of benefits..." but not specific details. The rule: include a section ONLY when posting has real, specific content for it — never emit heading followed by filler/placeholder text. Benefits: they mention benefits but not specific list; it's vague. Should we include Benefits section? It says "Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks..." This is still vague, not specific list. The rule says do not create Benefits section unless posting actually states them. It does state benefits exist but not specifics. Might be considered not specific enough. Safer to omit Benefits, Pay, Schedule.
We need to use for section headings. Use
for section headings. Use - for any list of duties/requirements/benefits, and
for prose.
We need to preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc.
We need to output only HTML fragment.
Let's extract content:
Job Description paragraph: "The Utilization Review RN will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. Active participation in program development and process improvement efforts is an expectation."
That's prose ->
.
Responsibilities: list of items after "Responsibilities". They are sentences separated by periods. We need to make
- for each duty.
List:
- Conducts inpatient admission, concurrent, and retrospective review for Medicare and Medicaid beneficiaries as well as managed care and self-pay patients based on CMS guidelines.
- Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
- Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services.
- Consistently identifies and records information on any progression-of-care/patient flow barrier and communicates with care team as necessary to notify of denial of continued stay so team can impact barriers.
- Collaborates with physicians and APRNs to influence appropriate utilization of resources, accurate status determination, and transitions of care.
- Educates members of the patient’s care team on the appropriate access to and use of various levels of care.
- Represents utilization management at various committees, professional organizations, and physician groups as needed.
- Promotes medical documentation that accurately reflects findings and interventions, presence of complications or comorbidities, quality and safety indicators, and patient’s need for continuing stay.
- Confers with attending physician and Physician Advisor if medically unnecessary inpatient treatment is contemplated.
- Coordinates appeals to denials as necessary.
- Serves as a resource person to physicians, nurses, billing office and other external departments for coverage and compliance issues.
- Other duties as assigned
Education: "Bachelor's Degree - Graduate from school of nursing. - Required Bachelor's Degree - BSN - Preferred". We need to preserve. Could format as
- maybe? It's a list of requirements. Use
- .
Work Experience: "3 Years - Clinical or managed care experience - Required Knowledge of medical necessity guidelines - Preferred". Also list.
Licenses and Certifications: "Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in state of Missouri - Required Upon Hire". List.
Travel Requirements: "Must be able to travel between various system facilities and off-site locations as needed. - Required". Could be
or
. It's a single statement; we can use .
Qualifications: heading "Qualifications Skills and Abilities". Then subcategories: Essential Technical/Motor Skills, Interpersonal Skills, Essential Physical Requirements, Essential Mental Abilities, Essential Sensory Requirements, Exposure to Hazards, Other Skills And Abilities. We need to decide if we should break into sections? The rule: use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we could have a heading "Qualifications" and then within that we could have subheadings? But only h3 allowed for section headings; we could still use for each subsection? Might be okay but they'd be same level. However they said use h3 for section headings (list). It doesn't forbid multiple h3s. We'll treat each major heading as h3: About the role, Responsibilities, Education, Work Experience, Licenses and Certifications, Travel Requirements, Qualifications, Skills and Abilities, About Us.
But Qualifications and Skills and Abilities may overlap. The posting has "Qualifications Skills and Abilities" as a heading then bullet list. We could treat that as one section "Qualifications" with subpoints. Or we could split into "Qualifications" and "Skills and Abilities". The content under that heading includes Essential Technical/Motor Skills etc. That's more like skills. So maybe we make a section "Skills and Abilities". The heading "Qualifications Skills and Abilities" could be considered as "Qualifications". But we already have Education, Work Experience, Licenses as qualifications. To avoid duplication, we could make a section "Skills and Abilities" for the list under that heading. And maybe keep "Qualifications" as a heading for Education, Work Experience, Licenses, Travel Requirements? But the rule says prefer few substantive sections over many thin ones. So we could combine Education, Work Experience, Licenses, Travel Requirements under a single "Qualifications" section. Then Skills and Abilities separate.
Let's think: The posting sections: Job Description, Responsibilities, Education, Work Experience, Licenses and Certifications, Travel Requirements, Qualifications Skills and Abilities, About Us.
We could output:
About the role
...
Responsibilities
...
Qualifications
... education, work experience, licenses, travel requirements
Skills and Abilities
... list of technical, interpersonal, physical, mental, sensory, hazards, other
About Us
...
We need to ensure we don't create empty sections.
Now extract details for each.
About the role paragraph: as above.
Responsibilities list: we have items.
Qualifications: combine:
Education:
- Bachelor's Degree - Graduate from school of nursing. - Required
- Bachelor's Degree - BSN - Preferred
Work Experience:
- 3 Years - Clinical or managed care experience - Required
- Knowledge of medical necessity guidelines - Preferred
Licenses and Certifications:
- Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in state of Missouri - Required Upon Hire
Travel Requirements:
- Must be able to travel between various system facilities and off-site locations as needed. - Required
We could keep each as - .
Skills and Abilities: list items:
Essential Technical/Motor Skills: Hand/eye coordination; speaks clearly; good hearing; computer skills/telephone skills and voice recorder skills.
Ability to read, write, and speak clearly.
Interpersonal Skills: Must be able to teach, provide accurate and concise information, answer questions, demonstrate excellent leadership skills, maintain positive relationships with multiple customers, motivate and persuade others.
Essential Physical Requirements: Physical requirements include standing, walking, and fine motor skills; reaching for items; bend, squat, sit, and climb stairs. Sufficient strength and mobility to sit for long periods of time (depending on assignment).
Essential Mental Abilities: Critical thinking skills, problem-solving skills, negotiating abilities. Capable of determining appropriate response to emergency situations. Ability to focus and concentrate in order to correctly perform tasks despite numerous distractions and interruptions. Ability to maintain professional demeanor to communicate and interact with patients, customers and team members.
Essential Sensory Requirements: Appropriate functional vision, hearing acuity.
Exposure to Hazards: Eye and neck strain.
Other Skills And Abilities: (none specified? Actually after that heading there is no further detail; maybe it's just a heading with no content). The posting says "Other Skills And Abilities" then nothing else. That's a placeholder; we should not include it if no specific content. So we omit that line.
Thus Skills and Abilities list includes the above items (excluding the empty Other Skills And Abilities). We'll make each bullet as a sentence.
About Us paragraph: "Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey."
We need to preserve all substantive information. That's fine.
Now produce HTML.
We must not include or . Just fragment.
Let's craft.
Be careful to escape any HTML special characters? Not needed.
We'll output:
About the role
The Utilization Review RN will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. Active participation in program development and process improvement efforts is an expectation.
Responsibilities
- Conducts inpatient admission, concurrent, and retrospective review for Medicare and Medicaid beneficiaries as well as managed care and self-pay patients based on CMS guidelines.
- Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
- Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services.
- Consistently identifies and records information on any progression-of-care/patient flow barrier and communicates with care team as necessary to notify of denial of continued stay so team can impact barriers.
- Collaborates with physicians and APRNs to influence appropriate utilization of resources, accurate status determination, and transitions of care.
- Educates members of the patient’s care team on the appropriate access to and use of various levels of care.
- Represents utilization management at various committees, professional organizations, and physician groups as needed.
- Promotes medical documentation that accurately reflects findings and interventions, presence of complications or comorbidities, quality and safety indicators, and patient’s need for continuing stay.
- Confers with attending physician and Physician Advisor if medically unnecessary inpatient treatment is contemplated.
for prose. We need to preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. We need to output only HTML fragment. Let's extract content: Job Description paragraph: "The Utilization Review RN will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. Active participation in program development and process improvement efforts is an expectation." That's prose ->
. Responsibilities: list of items after "Responsibilities". They are sentences separated by periods. We need to make
- for each duty.
List:
- Conducts inpatient admission, concurrent, and retrospective review for Medicare and Medicaid beneficiaries as well as managed care and self-pay patients based on CMS guidelines.
- Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
- Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services.
- Consistently identifies and records information on any progression-of-care/patient flow barrier and communicates with care team as necessary to notify of denial of continued stay so team can impact barriers.
- Collaborates with physicians and APRNs to influence appropriate utilization of resources, accurate status determination, and transitions of care.
- Educates members of the patient’s care team on the appropriate access to and use of various levels of care.
- Represents utilization management at various committees, professional organizations, and physician groups as needed.
- Promotes medical documentation that accurately reflects findings and interventions, presence of complications or comorbidities, quality and safety indicators, and patient’s need for continuing stay.
- Confers with attending physician and Physician Advisor if medically unnecessary inpatient treatment is contemplated.
- Coordinates appeals to denials as necessary.
- Serves as a resource person to physicians, nurses, billing office and other external departments for coverage and compliance issues.
- Other duties as assigned
Education: "Bachelor's Degree - Graduate from school of nursing. - Required Bachelor's Degree - BSN - Preferred". We need to preserve. Could format as
- maybe? It's a list of requirements. Use
- .
Work Experience: "3 Years - Clinical or managed care experience - Required Knowledge of medical necessity guidelines - Preferred". Also list.
Licenses and Certifications: "Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in state of Missouri - Required Upon Hire". List.
Travel Requirements: "Must be able to travel between various system facilities and off-site locations as needed. - Required". Could be
or
- . It's a single statement; we can use
- .
Skills and Abilities: list items:
Essential Technical/Motor Skills: Hand/eye coordination; speaks clearly; good hearing; computer skills/telephone skills and voice recorder skills.
Ability to read, write, and speak clearly.
Interpersonal Skills: Must be able to teach, provide accurate and concise information, answer questions, demonstrate excellent leadership skills, maintain positive relationships with multiple customers, motivate and persuade others.
Essential Physical Requirements: Physical requirements include standing, walking, and fine motor skills; reaching for items; bend, squat, sit, and climb stairs. Sufficient strength and mobility to sit for long periods of time (depending on assignment).
Essential Mental Abilities: Critical thinking skills, problem-solving skills, negotiating abilities. Capable of determining appropriate response to emergency situations. Ability to focus and concentrate in order to correctly perform tasks despite numerous distractions and interruptions. Ability to maintain professional demeanor to communicate and interact with patients, customers and team members.
Essential Sensory Requirements: Appropriate functional vision, hearing acuity.
Exposure to Hazards: Eye and neck strain.
Other Skills And Abilities: (none specified? Actually after that heading there is no further detail; maybe it's just a heading with no content). The posting says "Other Skills And Abilities" then nothing else. That's a placeholder; we should not include it if no specific content. So we omit that line.
Thus Skills and Abilities list includes the above items (excluding the empty Other Skills And Abilities). We'll make each bullet as a sentence.
About Us paragraph: "Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey."
We need to preserve all substantive information. That's fine.
Now produce HTML.
We must not include or . Just fragment.
Let's craft.
Be careful to escape any HTML special characters? Not needed.
We'll output:
About the role
The Utilization Review RN will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. Active participation in program development and process improvement efforts is an expectation.
Responsibilities
- Conducts inpatient admission, concurrent, and retrospective review for Medicare and Medicaid beneficiaries as well as managed care and self-pay patients based on CMS guidelines.
- Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
- Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services.
- Consistently identifies and records information on any progression-of-care/patient flow barrier and communicates with care team as necessary to notify of denial of continued stay so team can impact barriers.
- Collaborates with physicians and APRNs to influence appropriate utilization of resources, accurate status determination, and transitions of care.
- Educates members of the patient’s care team on the appropriate access to and use of various levels of care.
- Represents utilization management at various committees, professional organizations, and physician groups as needed.
- Promotes medical documentation that accurately reflects findings and interventions, presence of complications or comorbidities, quality and safety indicators, and patient’s need for continuing stay.
- Confers with attending physician and Physician Advisor if medically unnecessary inpatient treatment is contemplated.
. Qualifications: heading "Qualifications Skills and Abilities". Then subcategories: Essential Technical/Motor Skills, Interpersonal Skills, Essential Physical Requirements, Essential Mental Abilities, Essential Sensory Requirements, Exposure to Hazards, Other Skills And Abilities. We need to decide if we should break into sections? The rule: use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we could have a heading "Qualifications" and then within that we could have subheadings? But only h3 allowed for section headings; we could still use
for each subsection? Might be okay but they'd be same level. However they said use h3 for section headings (list). It doesn't forbid multiple h3s. We'll treat each major heading as h3: About the role, Responsibilities, Education, Work Experience, Licenses and Certifications, Travel Requirements, Qualifications, Skills and Abilities, About Us. But Qualifications and Skills and Abilities may overlap. The posting has "Qualifications Skills and Abilities" as a heading then bullet list. We could treat that as one section "Qualifications" with subpoints. Or we could split into "Qualifications" and "Skills and Abilities". The content under that heading includes Essential Technical/Motor Skills etc. That's more like skills. So maybe we make a section "Skills and Abilities". The heading "Qualifications Skills and Abilities" could be considered as "Qualifications". But we already have Education, Work Experience, Licenses as qualifications. To avoid duplication, we could make a section "Skills and Abilities" for the list under that heading. And maybe keep "Qualifications" as a heading for Education, Work Experience, Licenses, Travel Requirements? But the rule says prefer few substantive sections over many thin ones. So we could combine Education, Work Experience, Licenses, Travel Requirements under a single "Qualifications" section. Then Skills and Abilities separate. Let's think: The posting sections: Job Description, Responsibilities, Education, Work Experience, Licenses and Certifications, Travel Requirements, Qualifications Skills and Abilities, About Us. We could output:
About the role
...
Responsibilities
- ...
Qualifications
- ... education, work experience, licenses, travel requirements
Skills and Abilities
- ... list of technical, interpersonal, physical, mental, sensory, hazards, other
About Us
...
We need to ensure we don't create empty sections. Now extract details for each. About the role paragraph: as above. Responsibilities list: we have items. Qualifications: combine: Education: - Bachelor's Degree - Graduate from school of nursing. - Required - Bachelor's Degree - BSN - Preferred Work Experience: - 3 Years - Clinical or managed care experience - Required - Knowledge of medical necessity guidelines - Preferred Licenses and Certifications: - Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in state of Missouri - Required Upon Hire Travel Requirements: - Must be able to travel between various system facilities and off-site locations as needed. - Required We could keep each as - .
Skills and Abilities: list items:
Essential Technical/Motor Skills: Hand/eye coordination; speaks clearly; good hearing; computer skills/telephone skills and voice recorder skills.
Ability to read, write, and speak clearly.
Interpersonal Skills: Must be able to teach, provide accurate and concise information, answer questions, demonstrate excellent leadership skills, maintain positive relationships with multiple customers, motivate and persuade others.
Essential Physical Requirements: Physical requirements include standing, walking, and fine motor skills; reaching for items; bend, squat, sit, and climb stairs. Sufficient strength and mobility to sit for long periods of time (depending on assignment).
Essential Mental Abilities: Critical thinking skills, problem-solving skills, negotiating abilities. Capable of determining appropriate response to emergency situations. Ability to focus and concentrate in order to correctly perform tasks despite numerous distractions and interruptions. Ability to maintain professional demeanor to communicate and interact with patients, customers and team members.
Essential Sensory Requirements: Appropriate functional vision, hearing acuity.
Exposure to Hazards: Eye and neck strain.
Other Skills And Abilities: (none specified? Actually after that heading there is no further detail; maybe it's just a heading with no content). The posting says "Other Skills And Abilities" then nothing else. That's a placeholder; we should not include it if no specific content. So we omit that line.
Thus Skills and Abilities list includes the above items (excluding the empty Other Skills And Abilities). We'll make each bullet as a sentence.
About Us paragraph: "Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey."
We need to preserve all substantive information. That's fine.
Now produce HTML.
We must not include or . Just fragment.
Let's craft.
Be careful to escape any HTML special characters? Not needed.
We'll output:
- .
Work Experience: "3 Years - Clinical or managed care experience - Required Knowledge of medical necessity guidelines - Preferred". Also list.
Licenses and Certifications: "Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in state of Missouri - Required Upon Hire". List.
Travel Requirements: "Must be able to travel between various system facilities and off-site locations as needed. - Required". Could be
- maybe? It's a list of requirements. Use