Utilization Review Registered Nurse

Job description

Current Employees: If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage. Primary Location: Rapid City, SD USA Department: RCH Utilization Review Scheduled Weekly Hours: 40 Starting Pay Rate Range: $75,712.00 - $94,640.00 (Determined by the knowledge, skills, and experience of the applicant.) Job Summary: Responsible for review and completion of denial/appeal requests. Stays current with Federal and State regulations regarding medical necessity for inpatient and observation hospitalizations. Will collaborate with Case Managers, Utilization Review Medical Directors, Corporate Compliance, Admissions and Patient Financial Services on patient status for accuracy of billing. Responsible for utilization review duties in collaboration with Case Managers. Completes audits for appropriate utilization of resources, develops/implements action plans when appropriate. Establishes goals and priorities consistent with mission and goals of Monument Health, as well as meets requirements of Joint Commission and other applicable federal, state and local regulatory and/or accrediting...