Job Information
Vermont Employer RN - Case Manager/Utilization Review- FT/80 $10,000 Sign on Bonus in Springfield, Vermont
This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1147852
Job Type
Full-time
Description
The Utilization Review Registered Nurse (RN) will:
- Assist in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers, in conjunction with the admitting/attending physician.
- Partner with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed.
- Conduct concurrent reviews as directed in the hospital\'s Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented.
- Along with other health care team members, monitor the use of hospital resources and identifies delays.
##### \$10,000 SIGN-ON BONUS FOR EXPERIENCED PROFESSIONAL#####(External candidates only)
Requirements
::: {bind="html: Job.Requirements"} - Associate degree in Nursing from an accredited school - Bachelor of Science in Nursing (BSN) from an accredited school of nursing (preferred) - Three (3) years of recent clinical or utilization management experience - Competence in standardized medical necessity criteria (preferred) - Three (3) years of recent case management or utilization management experience. (preferred) - Current Vermont RN licensure in good standing with no restrictions or stipulations or multistate compact licensure in good standing with no restrictions or stipulations - Basic Life Support (BLS) for Healthcare Providers - Accredited Case Manager (ACM) certification, Certified Case Manager (CCM) or Case Management Administrator Certification (CMAC) certification (preferred) - Ability to understand, interpret, and explain data for utilization management functions. - Highly developed written, verbal, and presentation skills. - Possesses knowledge of care delivery systems across the continuum of care, including trends and issues in care reimbursement. - Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management. :::