Easter Seals Jobs

Employment Type:

Part time

Shift:

Description:

The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or

maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

On-Site Position

Reviews hospital admissions to ensure appropriate admission status in accordance with Indicia/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.

Monitors on an on-going basis case assignment for Managed Care Companies authorization of hospital stay.

Reviews urgent cases authorized for one day within 24 hours of admission. Reviews concurrent cases and discharge plans in timeframes determined in the review process with external entities.

Provides clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.

Responsible for educating and communicating Physicians regarding appropriate.

Observation and Inpatient admission criteria in accordance with Indicia/InterQual criteria, CMS, and Managed Care regulations.

Coordinates Physician Advisor referrals with there are concerns regarding meeting level of care criteria (utilizing Indicia/InterQual). Reviews PA referrals with department manager as needed.

Ensure Observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation, from the ED or as directed admit. This time will be identified by the time the order for Observation is written by the attending physician. Extended Recovery services begin after an ambulatory surgery patient arrives on the unit after the routine period ends.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran