Do Utlization Reviews in Idaho Require a Nurse
St. Luke'due south Health Organization is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Boise, Idaho.
Job description & requirements
- Specialty: Utilization Review
- Bailiwick: RN
- Start Appointment: ASAP
- Duration: Ongoing
- Shift: flexible
- Employment Blazon: Permanent
Overview
St. Luke'southward Health System is seeking an Utilization Reviewer to join our Utilization Management team.
The Utilization Reviewer – RN is responsible for evaluating medical necessity for patient hospitalization and acting every bit an internal resource for patient care. Ensures that utilization functions are complying with hospital procedures and federal regulations.
Responsibilities
- Conducts timely clinical decision review for services requiring prior say-so in a variety of clinical areas, including simply not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports, and Home Health.
- Reviews the medical necessity of access, continued hospitalization, length of stay, and any potential denial of payment issues. Applies established criteria and employs clinical expertise to translate clinical criteria to determine medical necessity of services. Performs Medicaid and Medicare review.
- Provides feedback and help to other members of the healthcare team regarding the appropriate use of resources and timely follow-through with the program of intendance. Communicates results of reviews to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements.
- Partners with physicians and other clinical departments to ensure appropriate cost-constructive care. Facilitates escalated reviews in accordance with Standard Operating Procedures and in collaboration with clinical, medical staff and peer review teams. Handles complex utilization management related issues, seeks consultation when advisable.
- Provides decision-making guidance to clinical teams on service planning. Ensures compliance with hospital, state, and federal regulations and requirements.
- Documents clinical decisions accurately and timely, working with utilization management leadership to ensure consistency in applying policy, every bit needed. Works with utilization direction and clinical leadership teams to ensure policies, procedures, and regulatory and contractual requirements are met.
- Provides ongoing communication with health programme utilization departments regarding medical necessity for prospective, concurrent, and retrospective reviews. Collaborates with physicians related to appropriateness of admission and the prevention of denials. Intervenes when potential denials are determined and facilitates appeals when concurrent denials are received. Creates and maintains database of denied service requests.
- Maintains a broad noesis of health care delivery that includes but is not limited to managed intendance regulations, contract terms/stipulations, utilization review and governmental bureau regulations.
- Perform other duties and responsibilities every bit assigned.
Qualifications
QUALIFICATIONS:
- Educational activity: BSN or ASN and two additional years of experience
- Experience: 3 years of RN or utilization management experience
- Licenses/Certifications: Electric current RN license in Idaho
Preferred Experience
- ICU, Trauma, Critical Care, or ED Experience
Why St. Luke'southward
A stiff, talented staff is at the middle of St. Luke's Health Organization. We are the state's largest employer with more than 15,000 employees and a medical staff of more 1,800 physicians and avant-garde practice providers. We're proud of our people who deliver skilled, empathetic care every day, and are looking to add together dedicated individuals who will continue this same tradition of excellence.
For more than information, delight contact Julie Leguineche at
*St. Luke's is an equal opportunity employer and does not discriminate against whatsoever person on the basis of race, faith, color, gender, gender identity, sexual orientation, age, national origin, inability, veteran status, or any other status or condition protected by police force.
Benefits
- Wellness and fitness programs
- Discount programme
- Mileage reimbursement
- Life insurance
- Vacation Pay
- Referral bonus
- Guaranteed Hours
- Employee assistance programs
- Continuing Education
- Medical benefits
- 403b retirement plan
- Dental benefits
- Ill pay
- Vision benefits
Facility Location
701 Morrison Knudsen Dr, Boise
Boise, Idaho
About St. Luke's Health System
A strong, talented staff is at the center of St. Luke'southward Health Organisation. We are Idaho'due south largest employer with more than than 15,000 employees and a medical staff of more than than 1,800 physicians and advanced practise providers. Nosotros're proud of our people who evangelize skilled, empathetic intendance every 24-hour interval, and are looking to add dedicated individuals who volition continue this same tradition of excellence.
Want to hear more than?
We'll start a conversation with Julie Leguineche from St. Luke'south Health System to answer any additional questions yous might have. No obligation, no fuss.
Source: https://www.vivian.com/job/1251-2021-53836/
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