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    "requisitionDescription": "<div><div><div><div><div><div><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong><em>Utilization Review RN - Per Diem*</em></strong></span></p><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><em><strong>*IMPORTANT NOTE: &nbsp;In lieu of benefits due to &quot;per diem&quot; status, 15% will be added to the hourly rate. Per diem employees are offered work on an &quot;as-needed&quot; basis.</strong></em></span></p><h2 id=\"isPasted\"><span style='font-family: \"times new roman\", serif; font-size: 16px;'><u>POSITION SUMMARY:</u></span></h2><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'>Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center&#39;s utilization review plan, state and federal regulations, insurance company requirements for reimbursement.</span></p><p><br></p><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><u>POSITION REQUIREMENTS:</u></span></p><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Minimum Education</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>A Bachelor&#39;s Degree in Nursing preferred; three (3) years of clinical care or nursing experience; OR an equivalent combination of education and experience AND (2) two years&rsquo; experience Utilization Review.</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Certificate Preferred</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>CCM (certification in case management) is preferred.</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>License Required</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Must be licensed as a Registered Nurse by the State of Nevada, and remain active with all annual licensing requirements.</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Minimum Work Experience</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Minimum of 1 year of case management or utilization management experience.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Knowledge of InterQual or McKesson criteria preferred.&nbsp;</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Knowledge in conducting a medical record review for medical necessity.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Knowledge of basic ICD-10, CPT coding knowledge preferred.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Basic knowledge of regulations as set forth by The Centers for Medicare Medicaid Services.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Skill in operating a personal computer utilizing a variety of software applications.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Strong written and oral communication skills</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Skill and ability to work independently</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'>&nbsp;</span></p><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><u>POSITION ESSENTIAL FUNCTIONS:</u></span></p><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Chart Review</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Conducts chart review to determine that InterQual-based care criteria is met.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Assist in determining if patients are in the correct hospital setting</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Review elective surgery schedule</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Review outpatient charts (observation)</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Obtains appropriate patient records as required by payor agencies and initiates the UR Medical Director as necessary for unwarranted admissions</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Hospital Reimbursements</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Understand and demonstrates the requirements needed to maximize reimbursement to the hospital</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Assist in obtaining authorizations as needed; including follow-up</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Respond to insurance providers in a timely and thorough manner</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Communicates with various hospital departments in a meaningful manner</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Assists in ensuring appropriate room charges, patient status, discharge disposition, etc.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Reviews denials and collaborates on appeals of denials</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Communicates with HIM staff and resolves discrepancies</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Knowledge</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Condition 44 documentation and requirement; HINN notification letters, ABN-advance beneficiary notice, Important Letter from Medicare, etc</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Maintains practices consistent with the hospital&#39;s utilization review (UR) plan</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Reviews the plans components and is a member of the utilization review committee</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Obtains data and statistics addressed in the hospital&#39;s UR plan and presents information as needed</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Ensures appropriate and cost-effective healthcare services to patients</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>Documentation</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Demonstrates understanding and supports clinical documentation improvement strategies</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Ability to efficiently locate priority clinical information in a medical record, and to critically interpret that information as part of a treatment plan.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Analyze clinical information to identify areas with potential for documentation improvement</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient&rsquo;s clinical status and care.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient&#39;s clinical status and care.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Reviews medical records concurrently, recognizes opportunities for documentation improvement, and follows up with appropriate staff.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Facilitates modifications to clinical documentation through collaborative interactions with physicians, nurses, and ancillary staff.</li></ul><p><span style='font-family: \"times new roman\", serif; font-size: 16px;'><br></span></p><p id=\"isPasted\" style=\"text-align: center;\"><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>CARSON VALLEY HEALTH IS PROUD TO BE RECOGNIZED AS A FINALIST IN THE</strong></span></p><p style=\"text-align: center;\"><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>&quot;BEST PLACES TO WORK&quot; - NORTHERN NEVADA, 2021, 2022, 2024 &amp; 2025!</strong></span></p><p style=\"text-align: center;\"><span style='font-family: \"times new roman\", serif; font-size: 16px;'><strong>WE LOOK FORWARD TO WELCOMING YOU TO OUR TEAM!!</strong></span></p></div></div></div></div></div></div>\n<br/>Per Diem positions have no guaranteed hours or set schedule. 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