Kettering Health Network

RN Utilization Review Specialist - Miamisburg - Full-Time - Varied Shift

Posted Date 1 month ago(5/17/2022 2:20 PM)
Job ID
2022-36683
Job Category
Registered Nurse
Job Type
Every Weekend Commitment
Shift
Varied Shift
# of Openings
1
FTE
72 Hours Per Pay Period/FTE 0.90

Overview

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Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

 

Our MissionOur VisionOur Values

Responsibilities & Requirements

Responsibilities:

 

  • Registered professional nurse with education, knowledge and experience.
  • Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status.  Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.
  • Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.
  • Identifies potential or actual denials for admission or ongoing stay both during the patient’s hospital stay and post discharge.
  • Review and decide the validity of medical necessity payer denials.  Submits payer denial appeals.
  • Participates in design of work flows and procedure to reduce incidence of denials.
  • Current unrestricted Ohio RN licensure, BSN required.

 

 

 

Requirements:

 

  • Current unrestricted Ohio RN licensure, BSN required.
  • 5 years clinical experience with 2 years utilization management
  • Utilization Management Preferred

  • MCG Care Guideline certification preferred

  • Works independently
  • Ability to adapt quickly to changing priorities and regulations
  • Experience with computers required.

 

Preferred Qualifications

Preferred:

  • Experience with Microsoft applications and EPIC software preferred

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