What are the responsibilities and job description for the UR Nurse (RN) position at Wilkes-Barre Hospital Company?
Reviews admissions to ensure the criteria for admission and ongoing hospitalization is documented and justified. Contacts appropriate third party payer to obtain initial and concurrent authorization for hospital services as well as conduct discharge and retrospective reviews. Works closely with the Business Office, Health Information Management and Social Service Department. Communicate denials to the Business/Finance offices and facilitate physician appeals with third party payers and send appeal letters when indicated. Participate in the Interdisciplinary Treatment Team meetings to discuss patient plan of care and need for continued inpatient hospitalization.
.Has knowledge of inpatient psychiatric care and psychotropic medication. Demonstrate written, verbal and computer skills and have the ability to interface with all disciplines. Proficiency in basic computer skills is required as well as the ability to work independently and organize and prioritize a multifaceted workload. Typically reports to a manager or head of a unit/department. Nursing degree from an accredited college, University, associate or diploma program. Current PA Registered Nurse License required with at least 3 years of experience. Utilization Review experience preferred.
