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Utilization Review Nurse/Case Management

Grand Lake Health SystemSt. Marys, Ohio
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Overview

Schedule
Alternate-schedule
Full-time
Part-time
Education
Nursing (RN, LPN)
Career level
Senior-level
Benefits
Career Development

Job Description

Hours of Job

  • Part Time - 40 hours/5 days per pay period
  • 7:30 AM-4:00 PM 
  • Every third weekend rotation off-site; less than 3 hours per scheduled weekend

Duties and Key Responsibilities

  • The Utilization Review Coordinator reviews and clarifies patient status, applies initial and continued stay criteria to determine medical necessity, prepares clinical reviews to support payer authorization of hospital stays, and follows inpatient and observation cases through resolution with clear, trackable documentation in WellSky CarePort.
  • Follows secondary review process as necessary.
  • Provides continued stay reviews for behavioral health and attends the twice weekly team meetings.
  • Identifies and documents avoidable variances and denial activity. Arranges P2P appeals. 
  • Audits and maintains compliance for IMM and MOON delivery.
  • Cross trains to other positions in Case Management for coverage needs
  • Must be receptive to changes as the position demands
  • Practices the Caring Model.

Requirements

  • Clinical/Psychosocial skills in acute care setting.
  • Strong team player with internal and external customers.
  • Must be adept and organized and work effectively and efficiently with staff and physicians
  • Patient advocacy, compliance, and confidentiality are a must.

Education/Certifications

  • Bachelor’s Degree from an accredited school is required.
  • Current Ohio Licensed Nurse.

Experience

  • Background in Nursing required with 5 years or more of recent acute care clinical experience.

Grand Lake Health System provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. GLHS complies with applicable state and local laws governing nondiscrimination in employment in all of our locations. In addition, Grand Lake Health System is an At-Will Employment employer.

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FAQs About Utilization Review Nurse/Case Management Jobs at Grand Lake Health System

What is the work location for this position at Grand Lake Health System?
This job at Grand Lake Health System is located in St. Marys, Ohio, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Grand Lake Health System?
Employer has not shared pay details for this role.
What employment applies to this position at Grand Lake Health System?
Grand Lake Health System lists this position under the following employment categories:
  • Alternate-schedule
  • Full-time
  • Part-time
What experience level is required for this role at Grand Lake Health System?
Grand Lake Health System is looking for a candidate with "Senior-level" experience level.
What education level is required for this job?
The education requirement for this position is Nursing (RN, LPN). Candidates with relevant qualifications or equivalent experience may also be considered.
What benefits are offered by Grand Lake Health System for this role?
Grand Lake Health System offers Career Development for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at Grand Lake Health System?
You can apply for this role at Grand Lake Health System either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.