Utilization Managment RN
Company: Benefis Health System
Location: Great Falls
Posted on: April 1, 2019
Serves as a physician consultant in the utilization review process
to determine legitimacy of admission, treatment, and length of stay
in the hospital to comply with government and insurance company
reimbursement policies and leads the case management team for
efficient and appropriate utilization of resources. Analyzes
patient records against insurance, governmental, and accrediting
agency standards to determine criteria concerning admissions,
treatment, and length of stay of patients and confers with medical
staff and nursing personnel and other professional staff to
identify appropriate level of care, length of treatment and length
of stay. Refers cases to leadership and facility utilization review
committee for review and course of action when case fails to meet
DUTIES AND RESPONSIBILITIES:
Works in collaboration with physicians and multiple departments
within the hospital to facilitate the most appropriate and
efficient utilization of services.
Must possess familiarity of utilization review processes and Center
for Medicare and Medicaid Services rules and regulations for
Must possess understanding of the complexity of various insurances
and asks appropriate questions to verify coverage.
Educates patients, families, physicians and hospital staff about
level of care criteria and appropriate parameters for documenting
severity of illness and intensity of care to be provided.
Collaborates with and leads Care Coordinators to insure patient
transition between levels of care, designated facilities, and
Demonstrates competency in the referral of direct or indirect
provision of individualized care of patients based on the patients
assessed age and developmental needs.
Must be able to achieve client (patient, family, and physician)
satisfaction given decreased resources, and increasing limitations
on hospital utilization.
Must understand the appropriate level for hospice patients,
understand appropriate placement in relation to Home Health,
Transitional Care, provision of Rehab services, oxygen/medical
equipment, and transportation needs.
Functions as a liaison between third party payors and responsible
for effective public relations between hospital departments and
Coordinators oversee all aspects of the utilization review process
taking on many tasks including data collection, analysis,
consulting and reporting.
Must perform other related duties and assigned tasks as requested,
which may include: cross training and/or other job functions as
temporary work loads and volumes require.
Must possess understanding of national health care trends and be
able to analyze trends that impact the hospital and community
Must assist in maintaining department records, reports, logs and
files as required. Complete monthly statistical forms in a timely
manner, if assigned.
Must participate in collecting data for process improvement as
Demonstrates the ability to deal with pressure to meet deadlines,
to be accurate, and to handle constantly changing situations.
Demonstrates the ability to deal with a variety of people, deal
with stressful situations, and handle conflict.
Graduate of an accredited college or university with a Bachelor's
Degree in Nursing required.
One to two years of utilization review and/or case management
Community Information: Great Falls has a city population of 60,000,
with a draw of over 275,000 people in north central Montana. We
experience mild winters and enjoy blue skies over 300 days per
year. Great Falls is a wonderful and safe place to raise a family,
with nationally ranked public schools and an average commute of
under 12 minutes, making the quality of life in Great Falls
unsurpassed in the Rocky Mountain West. Additionally, the Missouri
River, a blue-ribbon fly-fishing destination, runs through the
middle of town. Outdoor activities include camping, hiking,
horseback riding, water and snow skiing, rock and ice climbing,
boating, whitewater kayaking, off-road motorsports, upland bird and
waterfowl hunting, and big-game hunting.
Benefis Health System: This is your opportunity to be part of an
exceptional health system in a state that is well known for its
beautiful four seasons and outdoor lifestyle. While enjoying the
last best place, you'll have the added benefit of having access to
Benefis Health System, one of the state's most modern and
progressive healthcare facilities with 500+ beds and over 270
employed medical staff members representing more than 40
specialties. Our state-of-the-art facilities and cutting-edge
technologies make Benefis an exceptional working environment and
one of the "150 Top Places to Work in Healthcare" five years in a
Keywords: Benefis Health System, Great Falls , Utilization Managment RN, Healthcare , Great Falls, Montana
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