Dickinson County Healthcare System
The Dickinson County Healthcare System (DCHS) seeks a regular full-time Utilization Review Registered Nurse (RN) to join their Quality Management team in Iron Mountain, Michigan.
This position provides Utilization Review and Discharge Planning services to patients and acts as a liaison between medical and nursing staff, patients, relatives and appropriate agencies to facilitate the needs of the patient.
The Utilization Review RN reports to the Quality and Population Health Manager.
- Conduct admissions concurrent with retrospective utilization reviews for patients by screening inpatient and observation admissions to determine if they meet criteria for hospitalization.
- Stay current on changes in screening criteria.
- Assist the Utilization Review Coordinator in researching/preparing correspondence (insurance appeal letters, insurance denial of payment for stay letters).
- Maintain effective, appropriate and professional communication with hospital staff, care providers, peer review, commercial insurance review entities, and third-party payors to assure maximum reimbursement.
- Screen and assess patients for discharge planning based on age-related needs and make appropriate referrals to community agencies/hospital departments to assure continuity of care.
- Assist with hospital’s Swing Bed Program to identify and assure proper placement of candidates; inform physicians of possible placements in Swing Bed Program.
- Communicate with admitting/attending physicians regarding documentation and precertification requirements; maintain record of patient while hospitalized and work with physician to ensure optimal discharge planning.
- Comply with best practices in nursing and established hospital policies/procedures to render care of patients.
- Serve as Charge Nurse, as assigned.
WAGE/BENEFITS. Starting pay of $24.12 – $31.77 per hour based on years of experience. In addition, we offer medical, dental, vision, pension plan, paid time off (sick, vacation) and life insurance.
SCHEDULE. This is a regular, full-time Monday-Friday day-shift position. Shifts are generally 8 hours with a 7:00am start time. The Staff RN participates in the weekend rotation schedule.
MINIMUM AND PREFERRED QUALIFICATIONS.
- Licensed Registered Nurse in the State of Michigan required.
- Minimum of 2 years previous RN nursing experience required.
- Basic Cardiac Life Support (BCLS) certification or ability to obtain within 1 month of hire.
- Experience in Utilization Review and knowledge of DRG reimbursement system preferred.
- Ability to manage a diverse workload and prioritize tasks; assume management responsibilities as needed.
- Ability to physically and mentally carry out the functions of this position.
- Exceptional customer service skills with a professional demeanor that ensures trust, competence and compassion amongst patients, providers and team members.
- Ability to successfully pass a pre-hire drug screening and background check.
INTERESTED? Submit your application for employment at dchs.hirescore.com
ABOUT THE ORGANIZATION. DCHS has been named a 2020 Top 100 Rural & Community Hospital by The Chartis Center for Rural Health. This annual award honoring rural hospital performance is determined by the results of iVantage Health Analytics’ Hospital Strength INDEX®, which is celebrating its tenth anniversary in 2020. Learn more at dchs.org