RN Surgical Validation Nurse/Utilization Review Coordinator FT / 40 HRS
Company: CHRISTUS Health
Location: Santa Fe
Posted on: August 7, 2022
POSITION SUMMARY: Registered Nurse uses approved screening criteria
(MCG -/CMS Inpatient List) to determine the medical necessity of a
requested hospitalization and the appropriate level of care for
that patient. Actively involved in the continued management of
patient status/LOC. Provides consultative role as utilization
management nurse to clinical and non-clinical departments.
Documents objective findings against approved indicators. Assists
with retrospective reviews and medical necessity denials per
communication with third party payors. Follows UR policies and
procedures and assists with continually improving the quality and
effectiveness of the utilization management program at CSV.
RN is responsible to oversee outpatient and inpatient surgical
procedures to ensure the authorizations and status determinations
obtained prior to surgery by the clinics are correct. If they find
errors in status and/or authorization the RN is expected to work
closely with the outpatient clinic involved to rectify the
Keywords: CHRISTUS Health, Santa Fe , RN Surgical Validation Nurse/Utilization Review Coordinator FT / 40 HRS, Human Resources , Santa Fe, New Mexico
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