[Hiring] Utilization Review RN @University of Arkansas for Medical Sciences

Role Description

This is a full-time position working four 10 hour shifts; (0630-1700) Thursday - Sunday. Must live within one hour of Little Rock campus.

The Utilization Review (UR) RN Care Manager is responsible for:

• Utilizing pre-established, evidence-based screening criteria to validate the appropriateness of patient admissions.
• Providing screening and continuous observation status monitoring.
• Communicating relevant information to appropriate payer carriers regarding a patient’s stay.
• Reflecting appropriate knowledge of the RN scope of practice, current state requirements, CMS Conditions of Participation, Patient Bill of Rights, AB 1203, and other Federal or State regulatory agency requirements specific to discharge planning.

Qualifications

• Minimum Qualifications:
• ADN, or Diploma RN Degree.
• 5 years RN experience with current BLS certification.
• Valid Arkansas Registered Nursing License.
• Preferred Qualifications:
• BSN.
• Certified Case Manager (CCM) or American Case Management (ACM) certification.

Requirements

• Initiates appropriate referrals to internal and external interdisciplinary teams.
• Establishes a working diagnosis on every patient at the time of the initial review.
• Communicates the target length of stay and estimated discharge on every patient at the time of the initial review and coordinates the discharge planning process in collaboration with the interdisciplinary team.
• Documents all team, physician, and payer communication and concerns pertaining to coordinating of care and services.
• Responsible for utilizing pre-established evidence-based screening criteria to validate the appropriateness of patient admission and provide appropriate screenings of the patients assigned to a designated coverage area, including initial, continued stay and completion of discharge screens.
• Communicates with physicians regarding the level of care or admission status when appropriate criteria are not met for inpatient, observation, or continued stay review.
• Escalates appropriate cases to Physician Advisor for secondary review process.
• Escalates payer denial/appeal issues to the Physician Advisor/CMO/Attending in a timely fashion.
• Other duties as assigned to meet UAMS core values and the business needs of the department.

Benefits

• Health: Medical, Dental and Vision plans available for qualifying staff and family.
• Holiday, Vacation and Sick Leave.
• Education discount for staff and dependents (undergraduate only).
• Retirement: Up to 10% matched contribution from UAMS.
• Basic Life Insurance up to $50,000.
• Career Training and Educational Opportunities.
• Merchant Discounts.
• Concierge prescription delivery on the main campus when using UAMS pharmacy.

Company Description

The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.