Job details
Job type per diem
Full job description
Overview
Honorhealth is a non-profit, local community healthcare system serving an area of 1.6 million people in the greater phoenix areaThe network encompasses six acute-care hospitals, an extensive medical group, outpatient surgery centers, a cancer care network, clinical research, medical education, a foundation and community services with approximately 12,300 employees, 3,700 affiliated physicians and 3,100 volunteers.
Honorhealth was formed by a merger between scottsdale healthcare and john cLincoln health networkHonorhealth’s mission is to improve the health and well-being of those we serve.
As a community healthcare system, we have a unique responsibility to keep our facilities as safe as possible to protect our patients and team members while we work to achieve our mission, “to improve the health and well-being of those we serve.” therefore, honorhealth is requiring that all new hires have received the first dose of a covid-19 vaccine before they start, and be scheduled for their second doseReasonable accommodations will be considered.
Responsibilities
Job summary
The utilization review rn specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective careEnsures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary servicesResponsible for coordinating and conducting medical necessity reviews for all medicare, ahcccs, self-pay, and all other payers, upon admission and concurrently throughout the admission.
Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for all patientsPerforms initial and concurrent reviews on all patients entering the health care continuum.
Facilitates the delivery of services to patients and families through effective utilization of available resourcesPerforms medical record reviews, as required by payerInterfaces with care management team to provide information regarding quality outcome measurements (such as timeliness and appropriateness of services)Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues related to contract guidelinesWorks with medical records, finance and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
Initiates chart reviews, conducts follow-up reviews, and rounds on patients to ensure continuity of ur reviews.
Maintains a system to identify admissions with specific diagnosis / drg classifications or other categories of admissionsNotifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
Determines qualifications for hospital level of care based on set criteria.
Performs other duties as assigned.
Qualifications
Education
Associate`s degree in nursing from an accredited nln/ccne institution required
Experience
Three (3) years registered nurse in an acute care settingRequired
One (1) year experience in ur/um or case management required
Licenses and certifications
Registered nurse (rn) state and/or compact state licensure required
