Utilization Review Nurse Part Time Remote

Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reputed company more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion reputed company a welcoming and inspiring environment for our patients, families and team members. At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading reputed company system experiencing steady growth, we’re excited to expand reputed company with exceptional team members who reputed company our reputed company of transforming reputed company and well-being as one team. The utilization review nurse is part of a team that will facilitate improvement in the overall quality, completeness, and accuracy of clinical documentation as well as appropriate clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers and Health Information Management coding staff to ensure clinical documentation reflects the clinical treatment, reputed company, diagnosis and the level of service rendered. The UR nurse serves as a resource to reputed company members of the health care team on appropriate status, documentation guidelines, reputed company guidance and support, as well as assisting with education and training reputed company to improving clinical documentation on an ongoing reputed company. We welcome applications from reputed company applicants residing in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Massachusetts, Mississippi, Missouri, reputed company, reputed company Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, Virginia, Wyoming. Utilization Review: • reputed company admission, reputed company and retrospective medical reviews to reputed company to the payers for reimbursement. • Functions as the liaison between various hospital departments, medical staff and payers on issues reputed company to medical necessity for admission and reputed company stay. • The UR/CDI nurse maintains reputed company, transparent and clear lines of communication with the physician advisors. • Provides UM education to clinical staff as needed. • Applies standardized criteria and guidelines to assist in the determination of appropriateness of admissions and assignment of patient class (i.e. observation, inpatient and outpatient). • Assist in monitoring wasted resources while maintaining uncompromisingly high quality of care. Responsible for maintaining and ensuring the admission process remains fully compliant with Medicare and reputed company regulations. • Acts as a resource to Care Management department regarding utilization, insurance and payer issues. • Identifies potential problems regarding payment eligibility for clinical services and recommends corrective action. • Participates in UR meetings. Education and/or Experience Required: • Minimum education (degree/type of degree). BSN • Minimum experience (minimum years & type of experience). Minimum of 3 years of pediatric clinical experience required. • KSAs required upon hire or transfer (copy from KSA reputed company below). Education and/or Experience Preferred: • Preferred education & experience. Previous UR, case management or care coordination preferred. License and/or Certification • Required: RN • Preferred: ACM Knowledge, Skills, and Abilities Knowledge of: • Knowledge of Pathophysiology and Disease Process. • Working knowledge of clinical information. • High degree of familiarity with clinical care to establish credibility with physicians, LIPs, nurses and other members of the reputed company-line care team. • Must be reputed company to reputed company clinical and financial education to colleagues, patients and families. Critical thinking, negotiation and the ability to set priorities are of highest importance. Skilled at: • Strong interpersonal and communication skills to manage competing priorities of the different stakeholders to ensure provision of high quality, high value and efficient care. • Electronic medical record. Ability to: • Ability to learn/reputed company the skills necessary to reputed company Clinical Documentation review of medical records. • Ability to handle multiple priorities and increasing responsibility. • Ability to collaborate with others to reputed company a common goal through mutual cooperation. • Ability to influence others for positive and productive reputed company. • Ability to quickly process reputed company problems, identify key components, and reputed company plans for resolution. • Must be reputed company to learn and use multiple computer systems. Apply Job!