Full-Time LPN Utilization Review

DEPARTMENT: UTILIZATION REVIEW NURSE

JOB POSITION: LICENSED PRACTICAL NURSE

JOB STATUS:
Full-time position working flexible day shift hours, approximately 80 hours per pay period.

JOB QUALIFICATIONS:
Must be a graduate of Accredited School of Nursing and currently licensed in the state of Ohio. Preference given to candidates with previous clinical experience and EMR chart review.   Excellent verbal, written, and electronic communication skills.

 JOB DUTIES:
Primary responsibility of the Utilization Review Nurse is to complete admission authorization, initiate concurrent authorization, complete retrospective authorizations and maintain timely communication with all payers. The Utilization Review nurse initiates and coordinates the appeal process for all appropriate denied claims. An understanding of the severity of an array of illnesses, intensity of service and care coordination needs are key, as the Utilization Review must integrate clinical knowledge with billing knowledge to review, work with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings. The Utilization Review Nurse conducts quality chart review for quality outcome metrics and assists the Infection Prevention Director with daily surveillance as needed.

JOB AVAILABILITY:
To be discussed with the applicant at the time of interview.

COMPENSATION:
To be discussed with the applicant at the time of interview.

CONTACT PERSON:
If interested contact Valerie Schalk, Director Quality and Infection Prevention at vschalk@wyandotmemorial.org or fax resume/application to 419-209-0000.