Full-time Utilization Review RN needed at a top hospital on the southern coast of Maine!
The UR RN Nurse Care Manager assists the patient throughout their hospital experience to ensure that care provided is holistic, efficient, and appropriate in regards to all members of the healthcare/ multidisciplinary team and while focusing on the person and family to assist patients to understand their conditions and possible medical treatments. In order to decrease waste through stewardship of hospital resources, the emphasis is for the nurse in this role to review or audit patients' care using criteria that demonstrates medical necessity, and to achieve reimbursement for the services provided by the hospital providers and facility.
Additionally, this role assumes responsibility and accountability for denial management and appeals. This role will create a structure for resolution of root-cause denial trends by continuously working to identify opportunities for workflow improvements. This role will work to identify root cause breakdowns resulting in payer denials and collaborate with individuals across the revenue cycle to remove barriers and initiate workflow improvements. This role will assume ownership of denials reporting generation and distribution and education of end users.
*Applicants must have their BSN, nursing licensure in the State of Maine, and previous experience in Utilization Review.
Offering competitive compensation and complete benefits!
For more information, please submit your resume for review.