Utilization Review Nurse/Swing Bed Coordinator

Donalsonville Hospital is in need of a Full Time Monday-Friday UR/Swing Bed Coordinator.

Position Responsibilities:

• Assume responsibility for implementation of the Utilization Management Plan.
• Work with Hospital staff and physicians to educate and maintain current knowledge of Medicare, Medicaid and third party rules & regulations.
• Coordinate and follow through with the organization on-site audits and surveys by Medicare, Medicaid and third party payers.
• Perform admission and concurrent review.
• Perform Medicaid and insurance pre-certification as needed.
• Refer admissions and continued stays to the physician advisor when admission and continued stay are no longer met.
• Prepare & issue denial letters in cases on new covered non covered admissions or continued stay needs.
• Working knowledge of the functions of discharge planning, social services & patient representative.
• Present a positive image of the Hospital and support and promote the Hospital’s mission to patients, visitors, co-workers, vendors, and to the community as a whole.

Education:

• Graduate of Accredited school of nursing.
• Current/Active GA RN License.