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Registered Nurse (RN) Utilization Review (UR) - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Jacksonville, FL Jacksonville, Florida |
About this job
Memorial Hospital (an HCA facility) is located less than 20 miles from the beaches of Jacksonville.
We are the premiere medical facility in the Jacksonville area featuring a Certified Chest Pain Center, Certified Stroke Center as well as a dedicated Heart Center.
Memorial Hospital is also a U.S.
News and World Report Best Hospital. The Utilization Review (UR) Registered Nurse (RN) will work closely with all managed care insurance companies, Medicare, Medicaid ,as well as, Case Management, Case Management Director, Business Office, Benefits, and Admitting Office in obtaining authorization and certification of days for inpatient or observation days.
Determine medical necessity for all admissions and need for continued stay, as well as status the patient in the correct level of care-Observation vs.
Admission.
To keep the Case Manager informed about number of days certified.
To communicate with Case Management when more information or documentation is needed to receive certification.
To inform Case Management when clinical information is needed to be entered into the Midas System for reviews that need to be called into insurance companies.
To communicate as required by contract with managed care companies either by fax or phone and to log communication.
To work closely with the Business Office in preventing or reversing any possible denial.
To retrieve any documentation to show medical necessity of service when denial is received.
To forward such documentation to the parties submitting the denial and request a revision if indicated.
To identify inappropriate or untimely service that could result in a denial, partial denial or avoidable day.
To relay this information to the Case Manager and Utilization Director.
Enters certification days into Midas and next review date. EDUCATION: * A graduated from an accredited school of nursing is required * Associate Degree in Nursing required * Bachelor's Degree in Nursing preferred LICENSE/CERTIFICATION: * An active State of Florida Registered Nurse (RN) License is required EXPERIENCE: * 1 - 3 years of Case Management experience is required
We are the premiere medical facility in the Jacksonville area featuring a Certified Chest Pain Center, Certified Stroke Center as well as a dedicated Heart Center.
Memorial Hospital is also a U.S.
News and World Report Best Hospital. The Utilization Review (UR) Registered Nurse (RN) will work closely with all managed care insurance companies, Medicare, Medicaid ,as well as, Case Management, Case Management Director, Business Office, Benefits, and Admitting Office in obtaining authorization and certification of days for inpatient or observation days.
Determine medical necessity for all admissions and need for continued stay, as well as status the patient in the correct level of care-Observation vs.
Admission.
To keep the Case Manager informed about number of days certified.
To communicate with Case Management when more information or documentation is needed to receive certification.
To inform Case Management when clinical information is needed to be entered into the Midas System for reviews that need to be called into insurance companies.
To communicate as required by contract with managed care companies either by fax or phone and to log communication.
To work closely with the Business Office in preventing or reversing any possible denial.
To retrieve any documentation to show medical necessity of service when denial is received.
To forward such documentation to the parties submitting the denial and request a revision if indicated.
To identify inappropriate or untimely service that could result in a denial, partial denial or avoidable day.
To relay this information to the Case Manager and Utilization Director.
Enters certification days into Midas and next review date. EDUCATION: * A graduated from an accredited school of nursing is required * Associate Degree in Nursing required * Bachelor's Degree in Nursing preferred LICENSE/CERTIFICATION: * An active State of Florida Registered Nurse (RN) License is required EXPERIENCE: * 1 - 3 years of Case Management experience is required