280,000+ live roles 15,000+ active employers ✦ 760+ posted in 24h California market · 21,652 jobs Texas market · 19,164 jobs Florida market · 16,870 jobs New York market · 14,091 jobs California jobs · 21,652 Texas jobs · 19,164 Florida jobs · 16,870 New York jobs · 14,091 Healthcare · 127,264 jobs Patient Care · 116,281 jobs BLS · 55,500 jobs Registered Nurse · 50,534 jobs Documentation · 26,020 jobs CPR · 25,558 jobs 280,000+ live roles 15,000+ active employers ✦ 760+ posted in 24h California market · 21,652 jobs Texas market · 19,164 jobs Florida market · 16,870 jobs New York market · 14,091 jobs California jobs · 21,652 Texas jobs · 19,164 Florida jobs · 16,870 New York jobs · 14,091 Healthcare · 127,264 jobs Patient Care · 116,281 jobs BLS · 55,500 jobs Registered Nurse · 50,534 jobs Documentation · 26,020 jobs CPR · 25,558 jobs

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Utilization Review RN

Quick overview

Conducts admission and continued stay reviews to ensure hospitalization is warranted based on established criteria. Collaborates with physicians and payers to ensure appropriate patient status and progression of care.

Requirements summary

Must be a graduate of an accredited school of nursing. A valid RN license is required.

professional certificateCase ManagementRegulatory ComplianceCare CoordinationUtilization ReviewMedical Record ReviewPhysician CollaborationPatient Status DeterminationClinical Critical Thinking

Job description

Where You’ll Work CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health.
With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents.
Our world needs compassion like never before.
Our communities need caring and our families need protection.
With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.
Job Summary and Responsibilities Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.
Reviews include admission, concurrent and post discharge for appropriate status determination.
Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholdersregarding review outcomes.
Collaborates with facility RN Care Coordinators to ensure progression of care.
Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.
Communicates the need for proper notifications and education in alignment with status changes.
Job Requirements Graduate of an accredited school of nursing RN license

Utilization Review RN

Quick overview

Requirements summary

Job description

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