You haven't searched anything yet.
Summary
Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial Hospital, physicians, third-party payers and auditors to ensure information needs are met. This position will be deployed from the Summit Center, working closely with nursing supervisors, physicians admitting patients through the Emergency Department, Direct Admissions and surgical patients. The pre-admission phase incorporates all of the activities that occur prior to patient arriving in the hospital bed. Responsibilities include: ED review for correct patient classification (inpatient vs outpatient with Observation services), Direct admit and transfer review for correct patient classification (inpatient vs outpatient with observation services), elective surgery review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria. Case management activities in alignment with the revenue cycle include: Providing clinical review to payers for urgent/emergent admissions, admission InterQual/MCG review of all bedded patients, Medicare 2nd level physician review referral, collaborate with admitting team to establish appropriate status, confirm order and registration match.Maintains systems for monitoring patient admissions and extended stays for appropriateness and medical necessity by:
Anticipates and reviews denials and facilitates the appeal process by:
Serves as a Memorial Hospital and Beacon Health System resource regarding reimbursement by:
Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
Associate complies with the following organizational requirements:
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Nursing program. A valid and current Registered Nurse license in the state of Indiana is required. Two years of clinical experience is required. Two years of progressively responsible experience in a utilization review environment is preferred.
Knowledge & Skills:
Working Conditions:
Physical Demands:
Requires the physical ability and stamina to perform the essential functions of the position. Will be moving between Summit, the ECC and the surgical areas multiple times through-out the shift (based upon volumes of admissions through these areas).
Part Time
Ambulatory Healthcare Services
$100k-129k (estimate)
07/03/2024
09/01/2024
crossroadshealth.org
MENTOR, OH
100 - 200
Private
SPENCER KLINE
$10M - $50M
Ambulatory Healthcare Services