RN Utilization Review Job Portales area,New Mexico USA,Nursing

Job Title: RN Utilization Review
City: Portales
State: NM
Job Type: Travel
Discipline: RN
Speciality: Utilization Review
Facility Setting: Short Term Actut Care (STAC)
Accepting Locals per Radius Rule?: Yes
Contract Length: 13 weeks
Shifts: Days
Shift Details: Day 5x8-Hour
Weekly Schedule: 40 Hours
Certifications/License: Mandatory Experience:

Routine case management, discharge planning, swing bed coordinator and utilization review duties.
Evaluating and screening potential admissions to the facilities swing bed program
knowledgeable of criteria for Medicare, Medicaid, HMO, swing bed and private insurance coverage
Initiate ongoing communication with the resident and resident's family to assess discharge needs.
Actively involvement in daily rounds with bedside staff, physicians and ancillary team members
Communicate with physicians to ascertain their plans for a timely discharge.
document updates and discharge planning as an ongoing review.
Manage and collaborate with the healthcare team on swing bed placement and complete MDS documentation as necessary.
assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF, acute rehab and appointments.
Educates physicians and staff regarding appropriate level of care/utilization and required documentation that meets admission status
Run Interqual for each IP and OBS patient admitted to the floor

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