Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within a large nonprofit healthcare system
- Comprehensive benefits portfolio designed to support you and your family
- Chance to make a meaningful impact on patient care and community health
- Collaborative work environment with nearly 15,000 team members
- Engaging training and development programs to enhance your skills

What to Expect (Job Responsibilities):
- Review and monitor healthcare service utilization to ensure quality and cost-effectiveness
- Conduct medical necessity reviews for various payers upon admission and during the stay
- Collaborate with care management teams, physicians, and payers to resolve documentation issues
- Initiate and perform follow-up chart reviews, escalating issues to the Physician Advisor as necessary
- Maintain and manage systems to identify admissions with specific diagnoses or classifications

What is Required (Qualifications):
- Associate's Degree in Nursing from an accredited NLN/CCNE institution
- Minimum of 3 years of experience as a Registered Nurse in an acute care setting
- At least 1 year of experience in Utilization Review (UR), Utilization Management (UM), or Case Management
- Active Registered Nurse (RN) State and/or Compact State Licensure

How to Stand Out (Preferred Qualifications):
- Experience with medical record reviews and compliance with government regulations
- Familiarity with quality outcome measurements and appeals processes
- Strong communication skills to collaborate effectively with medical staff and payers

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