Similar Utilization Review (RN) jobs in Sitka, AK
Travel Nurse RN - Case Manager, Utilization Review
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Travel Nurse RN - Utilization Review
Sitka, AK
Providence Health Care Staffing
5x8 hrs
$3,640/weekOverview
- Start DateASAP
- Shift Breakdown5x8 hrs
- Duration13 weeks
Pay
Benefits
- Weekly pay
- Holiday Pay
- Guaranteed Hours
- Medical benefits
- Benefits start day 1
Description
MUST HAVE ACTIVE ALASKA LICENSE AT TIME OF SUBMISSION
MUST HAVE COVID VACCINES
Position Summary
This position oversees the day-to-day requirements of Utilization Management & Review, authorizing acute and sub-acute admissions at the Southeast Alaska Regional Health Consortium (“SEARHC”) Mount Edgecumbe Medical Center. This position works intensively with advanced systems to track and trend denials, build models for documentation improvement plans, and coordinate with all areas and levels of the hospital. This position works closely with the provider community to improve clinical documentation, and with administration to ensure appropriate utilization of hospital resources.
Under general supervision, provides professional assessment, planning, coordination, implementation, and reporting of complex clinical data. Maintains compliance with regulations affecting utilization management. Provider communication and behavior change can be challenging; this individual must be a master communicator and change agent. Clinical background required, as this position will be required to read, rapidly synthesize, and narrate a clinical event to patients’ third-party coverage for accurate and timely authorization and reimbursement. Must be able to understand and manipulate advanced systems and work with and synthesize large relational data sets, providing descriptive/predictive/prescriptive analytics to modify facility operational behavior.
Accountabilities
· Reviews patients’ records and evaluates patient progress. Performs prospective (admission), concurrent, and retrospective reviews and reconsideration reviews/appeals; collects data to determine appropriateness of admission and extended stay; records and transmits assessment findings, evaluations, and review decisions; completes reports on review decisions and activities; promotes quality improvement by identifying and referring issues affecting patient quality of care; insures compliance with Revenue Cycle billing processes, monitors the audit of cyclic reviews; certifies admission based on medical necessity. Analyzes patient records and participates in interdisciplinary collaboration with professional staff and Care Coordination team. Consults with the Care Coordination team regarding the level of nursing care and collaborates with other departments in the evaluation of projects affecting discharge plans.
· Facilitates educational programs and advises physicians and other departments of regulations affecting utilization management.
· Coordinates and attends all Quarterly Utilization Review meetings and provides information relative to the review process and any identified problems. Responsible for the agenda and meeting minutes; policy oversight with committee approval; performs any reviews and studies as delegated by the committee; serves primarily as a liaison between the hospital and any peer review organization and/or any other review agencies.
· Documents review information. Communicates results to claims adjusters (i.e. Revenue Cycle). Enters billing information as appropriate; prepares information for notification letters from providers and employees. Receives and processes requests for appeal of denials; responds to complaints per UR guidelines; maintains Utilization Review and appeal logs.
· Supports clinical improvement activities of SEARHC by providing quality review; records and reports all information within scope and authority.
· Performs any administrative duties; receives, logs, and files a variety of reports, charts, client interactions and other documents; performs other duties as assigned or required.
Baseline Qualifications
Education/Experienc
Employer
Providence Health Care Staffing
Would enjoy working with you when will be another position for CNA work up towards north aerator
Visit us at www.providencestaffing.com!
About Sitka, AK
As a travel nurse in Sitka, AK here's what you should know:- Sitka's cost of living is higher than the national average due to its remote location, with housing and groceries being particularly expensive.
- Wages may not fully match up with the higher cost of living.
- Average summer highs range from 57°F to 63°F, while winter lows range from 28°F to 35°F.
- Short term rentals may be limited in Sitka due to its remote location, but options may be available through local real estate agencies or online platforms.
- Sitka is not very car-friendly, as the town is relatively small and walkable.
- Public transportation options are limited, but biking and walking are popular due to the compact size of the town.
- Sitka has a diverse population with a mix of Native Alaskan, Caucasian, and Asian residents.
- The age range is varied, with a significant portion of the population being middle-aged or older.
- Common health issues may include seasonal affective disorder due to the long, dark winters.
- Sitka has a small but active community of travel nurses.
- Sitka offers a range of outdoor activities such as hiking, fishing, and wildlife viewing.
- There are also local restaurants serving fresh seafood, art galleries showcasing Native Alaskan art, and occasional music and cultural events.
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