Utilization Review RN - Per Diem*

• Hospital Reimbursements
• Understand and demonstrates the requirements needed to maximize reimbursement to the hospital
• Assist in obtaining authorizations as needed; including follow-up
• Respond to insurance providers in a timely and thorough manner
• Communicates with various hospital departments in a meaningful manner
• Assists in ensuring appropriate room charges, patient status, discharge disposition, etc.
• Reviews denials and collaborates on appeals of denials
• Communicates with HIM staff and resolves discrepancies

• Knowledge
• Condition 44 documentation and requirement; HINN notification letters, ABN-advance beneficiary notice, Important Letter from Medicare, etc
• Maintains practices consistent with the hospital's utilization review (UR) plan
• Reviews the plans components and is a member of the utilization review committee
• Obtains data and statistics addressed in the hospital's UR plan and presents information as needed
• Ensures appropriate and cost-effective healthcare services to patients

• Documentation
• Demonstrates understanding and supports clinical documentation improvement strategies
• Ability to efficiently locate priority clinical information in a medical record, and to critically interpret that information as part of a treatment plan.
• Analyze clinical information to identify areas with potential for documentation improvement
• Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient’s clinical status and care.
• Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.
• Reviews medical records concurrently, recognizes opportunities for documentation improvement, and follows up with appropriate staff.
• Facilitates modifications to clinical documentation through collaborative interactions with physicians, nurses, and ancillary staff.

Carson valley health is proud to be recognized as a finalist in the

"best places to work" - Northern nevada, 2021, 2022, 2024 & 2025!

We look forward to welcoming you to our team!!

Per Diem positions have no guaranteed hours or set schedule. The position will fill in for individuals who take unplanned and/or planned time off.