Registered Nurse Utilization Review
St. Luke's University Health Network · Allentown, Pennsylvania, US
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St.
Job description
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Registered Nurse Utilization Review will be responsible for substantiating medical necessity and clinical appropriateness of services in order to achieve quality outcomes and ensure appropriate reimbursement. JOB DUTIES AND RESPONSIBILITIES: Screens selected medical records in accordance with contractual agreements and departmental policies for appropriateness of admission; performing initial, continued stay, and retrospective reviews if applicable. Submits initial reviews and updates using established criteria and communicates with payers as appropriate, using established processes. Utilize established processes with the Physician Advisors to manage second level and peer to peer reviews. En...