Mohawk Valley Health System
Utica, NY, USA
Job Summary The RN - Utilization Management gathers clinical information to determine appropriateness of admission, continued stay, medical necessity, and appropriateness of patient status throughout a patient’s hospital stay. Efficiently processes payer authorization requests to obtain certification from insurance or payers. Collaborates with care managers, providers, discharge planners and other care team members. Core Job Responsibilities Complete initial admission reviews within 24 hours of admission, including reviews for those that were admitted during hours without an access nurse on duty. Ensure the appropriate level of patient care by utilizing expert level of clinical decision making, standard level of care criteria, commercial payor criteria, and attending physician communication and input. Consult with Physician Advisor for the cases not meeting criteria. Ensure that Physician Advisor Medical Necessity documentation is placed on the medical...
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Assistant & Support
Nursing
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