Utilization Review RN Coordinator (Pool)

Valleywise Health System • Mesa, Arizona, United States • 6h ago

Utilization Review RN Coordinator (Pool)

As a Valleywise Utilization Review RN Coordinator (pool), you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status and medical necessity for services provided through the acute care medical hospital. This requires a proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system. The RN Utilization Review Coordinator is responsible for assuring the appropriate use of resources and facilitating the patient’s progression through the continuum of care in a timely and cost-effective manner. This position works with managed care plans, third-party payers, the business office, and the interdisciplinary team to ensure authorization for reimbursement at the appropriate level is confirmed to ensure payment of expected reimbursement.

Hourly Pay Rate: $49.00

Qualifications

Education

Prefer a bachelor's degree in Nursing.

Experience:

Must have at least three (3) years of recent acute clinical RN hospital experience; preferably in Case Management and/or Utilization Management.

Specialized training:

Trained in Epic, InterQual, Midas and internally used software programs is strongly preferred.

Certification/licensure:

Must possess a current, valid Arizona RN licensure and be in good standing with the AZ Board of Nursing.
Prefer that specialty certification in utilization or case management be obtained within 30 months of hire.

Knowledge, Skills, and Abilities:

Must have a working knowledge of case management, hospital, community resources and resource/utilization management.
The position requires excellent communication and clinical skills and ability to maintain professional rapport with physicians.
Requires extensive knowledge of evidence based clinical guidelines, best practice, workup, treatment, prognosis and hospital procedures.
Critical thinking ability essential.
Strong critical care skills, understanding of medical documentation and pathophysiology.
Knowledge of acute care criteria sets and state and federal reimbursement programs.
Requires the ability to read, write and speak effectively in English.