RN Utilization Review Coordinator - Hope - Hospital - Okmulgee
On-siteOkmulgee, Oklahoma, United States
Job Summary
Conduct concurrent and retrospective utilization reviews to determine medical necessity and patient status for Medicare, Medicaid, HMO, and private insurance coverage. Obtain intake referrals, authorizations, and prior authorizations as needed for discharge, while collaborating with nursing, physicians, admissions, and compliance staff to answer clinical questions regarding medical necessity. Compile and analyze data to establish relevant plans and report findings to the Director and quality committee, ensuring accurate tracking and evaluation of diverse workloads within a fast-paced psychiatric hospital environment. Assist in medical and psychiatric emergencies according to protocol and maintain supplies for the unit.
Required Qualifications
- Associate Degree in Medical Field
- RN
- Minimum 2 years of experience working with Medicare, Medicaid and Private Insurance
- BLS
- CPI (or equivalent certifications required)
- Thorough knowledge of both hospital wide and unit specific policies and procedures, work practices, emergency procedures, and personal protective equipment
- Ability to maintain composure and professionalism during difficult and high stress situations
- Ability to interact and communicate with others in a way that promotes a positive and cooperative work environment and ability to channel concerns appropriately
- Ability and willingness to adjust personal schedule in case of workload fluctuations or other departmental/unit needs
- Ability to foster sense of teamwork and collaboration within the unit and the hospital
- Initiative and enthusiasm in performing job duties
- Understanding of concepts of excellence in customer service
- Acceptance and support of hospital mission, goals and objectives
- Capability to assist in medical and psychiatric emergencies according to protocol
- Capability to lift up to 50 pounds
- Regular attendance
- Professional attire
Desired Qualifications
- Bachelor's degree
- Knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage
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