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-paces, 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.
CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.
Requirements:
Work Type:
Per Diem As Needed
EEO is the law - click below for more information:
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.
Must have skills 3 yrs+ experience with handling system configurations in smart recruiters and avature CRM Experience Nice to have skills communication skills and business awareness able to speak the business language familiarity with ServiceNow and ...
...of Aramark proudly serve millions of guests every day through food and facilities in 15 countries around the world. Rooted in... ..., Instagram and Twitter.Job DescriptionWe know that a Food Production Manager's job isnt only about the food. It takes skills, dedication,...
...all ages and abilities. In this position with Presbyterians Outpatient rehabilitation department gives clinicians the opportunity to... ...scholarship opportunities Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a...
...Job Description Job Description Job Title: On-Call Event Servers & Bartenders Location: Dallas-Fort Worth Metroplex (Various Event Venues) Starting Pay: $22/hour (Based on Experience) About the Role: Low Country Quisine is looking for professional,...
...ManTech is seeking a motivated, career and customer-oriented System Administrator , to join our team in Hanover, MD . The team delivers enterprise infrastructure capabilities for a global workforce performing a wide range of missions in defense of our Nation. This...