Utilization Review Nurse/Case Management

apartment Grand Lake Health System location_onSaint Marys, OH 45885, US

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Hours of Job

Part Time - 40 hours/5 days per pay period
7:30 AM-4:00 PM
Every third weekend rotation off-site; less than 3 hours per scheduled weekend

Duties and Key Responsibilities

The Utilization Review Coordinator reviews and clarifies patient status, applies initial and continued stay criteria to determine medical necessity, prepares clinical reviews to support payer authorization of hospital stays, and follows inpatient and observation cases through resolution with clear, trackable documentation in WellSky CarePort.
Follows secondary review process as necessary.
Provides continued stay reviews for behavioral health and attends the twice weekly team meetings.
Identifies and documents avoidable variances and denial activity. Arranges P2P appeals.
Audits and maintains compliance for IMM and MOON delivery.
Cross trains to other positions in Case Management for coverage needs
Must be receptive to changes as the position demands
Practices the Caring Model.

Requirements

Clinical/Psychosocial skills in acute care setting.
Strong team player with internal and external customers.
Must be adept and organized and work effectively and efficiently with staff and physicians
Patient advocacy, compliance, and confidentiality are a must.

Education/Certifications

Bachelor’s Degree from an accredited school is required.
Current Ohio Licensed Nurse.

Experience

Background in Nursing required with 5 years or more of recent acute care clinical experience.

Grand Lake Health System provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. GLHS complies with applicable state and local laws governing nondiscrimination in employment in all of our locations. In addition, Grand Lake Health System is an At-Will Employment employer.

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