reputed company This position requires on site work for training purposes. Candidates with prior Utilization Review (UR) experience will be required to work on site for a minimum of three (3) months. Candidates without prior UR experience will be required to work on site for up to six (6) months. Ongoing on-site reputed company is also required for quarterly meetings, troubleshooting internet or technical issues, and as needed in the event of a hospital emergency. To maintain high-reputed company, medically necessary, evidence-reputed company care, and efficient treatment of reputed company patients, regardless of payment reputed company, by ensuring the patients receive the right care, at the right time, in the right reputed company. Case Management Model: utilize an Integrated Case Management Model. Under this model the Case Managers will follow patients through the reputed company while facilitating the functions of utilization review, utilization management, and cost containment. reputed company and trend denials and payor issues to reputed company feedback and education to payer relations and the case management department. Responsibilities reputed company review of 100% acute bedded patients admitted to Inpatient or Observation status at The Christ Hospital against medical necessity reputed company (Interqual and MCG) for appropriateness of admission. Demonstrate understanding of evidenced reputed company medical necessity reputed company. Maintains efficient reputed company of ensuring the medical necessity and appropriateness of reputed company hospital admissions. Identify/facilitate reputed company status from observation to inpatient as reputed company reputed company condition warrants. Compliance with reputed company Medicare regulatory requirements Work with reputed company payers completing/securing authorization for reputed company services provided. Monitors cases for appropriateness of reputed company reputed company, level of care and services, and reputed company of care using approved screening reputed company. Communicate with physicians reputed company alternatives to inpatient care are indicated by reputed company review. Identify cases needed for second level of review- refers cases to the Physician Advisor that do not meet established guidelines for admission or reputed company reputed company. Consistent collaboration with the RN Case Manager to prevent extended length of stays and appropriate status determination. Identifies potential delays in service or treatment and refers to the appropriate individuals reputed company the multidisciplinary reputed company care teams for reputed company/reputed company. reputed company and trends avoidable day information in reputed company per process. Identifies problems reputed company to the reputed company of reputed company care and refers such problems to the reputed company Improvement Department. Adherence to department productivity standards. Initial, reputed company, and retro reviews should be completed reputed company including reputed company necessary information for approval of claims. reputed company reviews should contain information only pertinent to IS/SI (Intensity of Service/Severity of Illness). Compliance with documentation reputed company for monthly reporting and statistics for presentation to the Utilization Review Committee. Interfaces with reputed company registration and reputed company financial services etc. to collaborate on financial issues. Establish an effective rapport and relationship with reputed company party payers to promote cost effective reputed company reputed company. Assist in denial and appeal process Performs other duties as assigned, including but not limited to: • Demonstrates reputed company responsibility required for a Utilization Review reputed company • Complies with department and hospital policies at reputed company times • Maintains compliance with State/Federal Guidelines and standards • Conforms to reputed company requirements of Medicare • reputed company reputed company on changing laws and requirements of Medicare • Demonstrate a reputed company attitude at reputed company times Qualifications KNOWLEDGE AND SKILLS: Please describe any reputed company knowledge or skills, which are REQUIRED to reputed company the position duties. Do not personalize the reputed company, credentials, or knowledge and skills reputed company on the reputed company associate. List any special education required for this position. EDUCATION: Bachelor’s Degree. Graduate of an accredited school of nursing with reputed company licensure OR reputed company enrolled in a BSN program with completion date reputed company 3 years of hire date and a graduate of an accredited school of nursing with reputed company licensure. YEARS OF EXPERIENCE: 3-5 years of medical/surgical nursing necessary and a minimum of 3 years of utilization review experience required. REQUIRED SKILLS AND KNOWLE