Gainesville, Georgia
Superior, Wisconsin
Clearlake, California
Wausau, Wisconsin
Chicago, Illinois
Gainesville, Georgia
Santa Barbara, California
Los Angeles, California
Posted: 23-Apr-26
Location: Los Angeles, California
Categories:
Internal Number: 16772
Job Description
- Validate patients' placement to be at the most appropriate level of care based on nationally accepted admission criteria
- Use medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay
- Secure authorization for clinical services through timely collaboration and communication with payers as required
- Follow the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review
- Collaborate with Care Coordinators to identify and follow up on Observation class patients
- Follow up with the payer to verify approval/authorization of the hospital stay (all dates of services)
- Function as an advocate, and contact person for the care team, patient/family when communicating with payers, and or outside agencies to ensure continuity of care, optimal clinical resource outcomes, and appropriate financial management for the patient and the organization
Qualifications
Educational Requirements:
Assoc. Degree/College Diploma Graduate of an accredited RN nursing program required
Bachelor's Degree Nursing preferred
Licenses:
RN State License
Basic Life Support (BLS)
Experience:
3 years In acute nursing required
2 years Case Management preferred
1 year CPT coding preferred
Physical Demands:
Lifting 50 lbs. Carrying 50 lbs. Pushing 75 lbs. Pulling 75 lbs. Balancing, Stooping, Kneeling, Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination
