About The Role

Registered professional nurse with education, knowledge and experience.- Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status. - Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.- Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.- Identifies potential or actual denials for admission or ongoing stay both during the patient’s hospital stay and post discharge.- Review and decide the validity of medical necessity payer denials. - Submits payer denial appeals.- Participates in design of work flows and procedure to reduce incidence of denials.- Current unrestricted Ohio RN licensure...

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RN Utilization Rvw Spclst - Utilization Management