What are the responsibilities and job description for the UTILIZATION REVIEW NURSE - Union General Health System - FT position at Union General Hospital?
Job description:
The Utilization Review Nurse at Union general Hospital is responsible for performing precerts to ensure payment for services performed at this hospital. This will include various areas of the hospital including OB, Nursery, Med/Surg, ICU and overflow units for both Inpatient and Observation patients. Also this nurse will be responsible for completing all appeals and denials for the the areas listed above. They will conduct medical necessity reviews and work to identify the most appropriate course of treatment that will result in cost effective and high quality medical care for the patient, according to the patient's insurance plan. Additionally, the nurse will work closely with the payers to ensure that the organization is fully compensated for any and all services delivered and will gain authorizations for any pending services and procedures not yet performed.
Education and experience : Graduate of an accredited nursing program with RN or BSN licensure. Two years of hospital utilization experience preferred.
***Knowledge in Cerner and MCG preferred***
