Medasource
Apply Now
Position: Pediatric UR RN
Location: Remote
Start: ASAP
Duration: 6+ month contract
General Description:
The Utilization Review Specialist (URS) reviews all Inpatient, Observation and Outpatient In A Bed patient charts at Nationwide Children’s Hospital by applying hospital approved, medical necessity criteria to evaluate appropriateness of admission status, level of care and continued stay, in an effort to assure optimal utilization of hospital resources and payer reimbursement. The URS acts as a liaison between the payer and the care team for the purposes of obtaining payer approval for admission, level of care and/or continued stay and gathers additional information from providers when necessary in order to negotiate with a payer if services are questioned. The URS may be called upon to assist the care team in developing alternative plans for the patient if continued stay criteria remains unmet. The URS is also responsible for conducting retrospective case reviews in response to post-discharge denials and may assist the UM Program Manager in collaborating with the attending physician, UM Medical Director or the UM Department Director to resolve these issues.
Job Functions:
• Utilizes clinical expertise, as well as a sound working knowledge of ageappropriate medical necessity criteria, to evaluate assigned patients for appropriate admission status as well as level of care and continued stay. (Continuously)
• Communicates clinical information to payers in order to obtain authorization and approval for services. Skillfully negotiates between the payer and the hospital, including facilitating peer to peer reviews, when services are questioned or denied in order to obtain approvals and minimize, or reverse, denials, (concurrently or after discharge). (Continuously)
• Actively collaborates with the multidisciplinary team throughout a patient’s hospitalization to assure criteria is met and intervenes as necessary when criteria is not met or is questionable. Interventions can include, but are not limited to, facilitating status changes, providing feedback to providers regarding documentation requirements, educating the care team on criteria specifications or assisting the care team with developing transition plans when criteria for continued stay is not met. (Frequently)
• Collaborates with ancillary departments, such as Managed Care or Registration, to assure accurate documentation of payer sources and demographics. (Frequently)
• Maintains knowledge of regulatory requirements and ensures regulatory compliance for assigned area. Participates in emergency response preparedness as needed. (Occasionally)
• Participates in the training and development of new and existing staff, including participation in peer evaluation. (Occasionally)
• Engages in “workplace community” by adopting changes to workflow in accordance with new processes or standards, participating in data collection or auditing, understanding and participating in department Quality Improvement initiatives, and representing the department at relevant meetings and relaying important information back to staff. (Occasionally)
Note: Regular, reliable and consistent attendance is an essential job function. Employees are expected to perform work as scheduled. Please see the physical requirements for this position listed below.
Experience: 3 years clinical nursing experience, with at least one year in pediatrics.
Skills:
Understanding and application of established medical necessity criteria, computer skills, verbal and written communication, critical thinking, problem solving, multidisciplinary collaboration, self-direction
Education:
BSN required
Licensure Requirement:
Current Ohio RN License
Pediatric UR RN Columbus, OH
For over 16 years, Medasource has established and maintained relationships that are designed to meet your IT staffing needs. Whether it’s contract, contract-to-hire, or permanent placement work, we customise our search based upon your company’s unique initiatives, culture and technologies. With our national team of recruiters placed at 21 major hubs around the nation Medasource finds the people best-suited for your business. When you work with us, we work with you. That’s the Medasource promise.
Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.
Benefits & Perks:
Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.
Pay Disclaimer:
The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.
JO-2504-167764