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Alexandria, Louisiana, Description Summary: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This RN is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast pace, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This RN effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. Requirements: BSN Degree from an accredited nursing program or proven success as Registered Nurse Utilization Review I role. Familiarity with criteria sets including InterQual and MCG preferred. Excellent verbal and written communication. Critical and analytical thinking skills. Demonstrated clinical competency. Three to Five years of experience in case management or utilization review or proven success as Registered Nurse Utilization Review I role. RN License in state of employment or compact required. CPR certification preferred. Certification in Case Management preferred. Work Schedule: PRN Work Type: Per Diem As Needed EEO is the law – click below for more information: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925.
