Utilization Review/ Concurrent Review
About The Position
Essential Functions: Authorize patient stays Submit insurance PA for hospital admission insurance. Continued stay submissions Discharge submission to insurance Appeals and Peer to Peer submission InterQual submission for medical necessity. Discharge planning for BHU and Acute Care. Conduct UR Committee. CDI Management Swing Bed intake process All other duties within the scope of practice. Working Conditions: Possible exposure to inside environmental conditions. Exposure to distressed patients, families or visitors. Physical Demands: Requires standing, sitting or walking for up to 8 hours or longer per day. The ability to lift up to 50 lbs. Qualifications: Graduate of an Accredited School of Practical Nursing or Registered Nursing or Graduate of an approved program in Respiratory Care or BSW/MSW from accredited school of social work required or similar education and experience; Missouri Licensure preferred
Requirements
- Graduate of an Accredited School of Practical Nursing or Registered Nursing or Graduate of an approved program in Respiratory Care or BSW/MSW from accredited school of social work required or similar education and experience
- Missouri Licensure preferred
Responsibilities
- Authorize patient stays
- Submit insurance PA for hospital admission insurance
- Continued stay submissions
- Discharge submission to insurance
- Appeals and Peer to Peer submission
- InterQual submission for medical necessity
- Discharge planning for BHU and Acute Care
- Conduct UR Committee
- CDI Management
- Swing Bed intake process
- All other duties within the scope of practice
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
Number of Employees
101-250 employees
