Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Engage in meaningful work that contributes to patient care and health outcomes
- Work in a dynamic and fast-paced environment with a focus on quality improvement
- Comprehensive training and resources provided to enhance professional development

What to Expect (Job Responsibilities):
- Perform initial clinical assessments and payer requested reviews to establish medical necessity for hospitalized patients
- Collaborate with physicians to obtain necessary documentation supporting hospital stays and discharge needs
- Document all actions and activities in the case management software system, ensuring thorough record-keeping
- Review concurrent denials and assist in coordinating Peer to Peer discussions to address authorization issues
- Communicate effectively with the UR Coordinator and facility case managers to ensure coordinated patient care

What is Required (Qualifications):
- Required Education: Associate's Degree in Nursing
- Minimum of 3 years previous nursing experience
- Required License/Registration/Certification: Licensed Practical Nurse or Licensed Registered Nurse
- Data entry skills and demonstrable proficiency with Google Docs, Google Sheets, and email applications
- Ability to read, review, prepare, and analyze written data and figures using a PC

How to Stand Out (Preferred Qualifications):
- Bachelor’s Degree in Nursing or higher
- 3+ years of experience in utilization review
- ACM or CCM Certification
- Experience with case management software systems
- Strong understanding of evidence-based criteria for medical necessity evaluations

#HealthcareServices #UtilizationManagement #NursingCareers #PatientCare #CareerGrowth

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