RN Surgical Validation Nurse/Utilization Review Coordinator FT / 40 HRS

Company: CHRISTUS Health
Location: Santa Fe
Posted on: August 7, 2022

Job Description:

Description
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 case.

Keywords: CHRISTUS Health, Santa Fe , RN Surgical Validation Nurse/Utilization Review Coordinator FT / 40 HRS, Human Resources , Santa Fe, New Mexico