RN Utilization Rvw Spclst - Utilization Mgmnt - Miamisburg - PT/Days
Posted Date 1 week ago (12/11/2023 10:04 AM)
Job ID 2023-46352
Job Category Registered Nurse
Job Type Part-Time
Shift Varied Shift
Department 705493 - UTILIZATION MANAGEMENT
FTE 40 Hours Per Pay Period/FTE 0.50
FTE 40 Hours Per Pay Period/FTE 0.50
Overview
Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
Campus Overview
Kettering Health Miamisburg
• Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years.
• Kettering Health Miamisburg, formerly Sycamore Medical Center, is a full-service hospital located minutes west of the Dayton Mall on Miamisburg-Centerville Road off I-75 in Miamisburg, Ohio.
• The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care.
• Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning.
• 142 bed facility
• Awarded with 100 Top Hospital by IBM Watson Health for the 10 th time in 2019.
• In 2020, KH Miamisburg received an “A” from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.
• Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.
• KH Miamisburg received several awards from Healthgrades: • Outstanding Patient Experience Award (2017-2019)
• America’s 100 Best Hospitals for Prostate Surgery Award (2020)
• Joint Replacement Excellence Award (2020)
Responsibilities & Requirements
• 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, BSN required.
Preferred Qualifications
• 5 years clinical experience with 2 years case management preferred
• Case Management certification preferred
• Works independently
• Familiar with MCG Care guidelines
• Ability to adapt quickly to changing priorities and regulations
• Experience with computers required.  Experience with Microsoft applications and EPIC software preferred
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