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Work Shift

Day (United States of America)

This role is FT Days, onsite here at Cobb hospital.

Minimum 3 years Strong clinical knowledge with clinical practice/experience Required

Sign on bonus and relocation assistance for eligible candidates.

Cobb Hospital:

Job Summary:

The Utilization Management (UM) Nurse is responsible for conducting medical necessity reviews up to 12 hours per day, on any of the 7 days per week, utilizing Indicia for Case Management, and performs clinical reviews through document review, discussion with physicians and collaboration with the care team on the coordination of safe transitions of care for a defined patient population. The UM Nurse will perform utilization review every day by looking at all new admissions, all observation cases and concurrent reviews. They will be assigned to specific units/and or payer/and or patient class. All clinical reviews will be done by utilizing mcg Indicia, Indicia for Admission Documentation (IAD), and Indicia for Effective Focus (IEF) criteria in conjunction with medical records documentation and communication with physicians and physician‘s advisors.

The UM nurse gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to complete the determination/recommendation for the most appropriate level of care status and shares pertinent clinical information to the payers. Along the continuum of care, the UM Nurse communicates with providers and other parties to facilitate care/treatment. UM Nurse identifies opportunities to ensure effectiveness of healthcare services in the most appropriate setting always, as well as timely discharge to the most appropriate level of post discharge care. The UM Nurse obtains timely authorization of all ALOS days from payers and ensures accurate and complete documentation in the appropriate place in EPIC to enable timely billing. UM RN monitors post-discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other