Job Description

Text 6049 to 765-523-4622 to Quick Apply for this Utilization Review Nurse opportunity!

Your dedication, our commitment

If you are a passionate, dedicated professional that wants to make a difference in our patients’ lives, then please consider the following open position:

Meridian Health Services at River Bend is currently seeking a full time Utilization Review Nurse for our Inpatient Program located in Lafayette, Indiana. This is a great opportunity to make an impact in the lives of others.

This is a full-time position working Monday through Friday 8am - 5pm.

Key Responsibilities of a Utilization Review Nurse:

• Screens all admissions for appropriateness according to criteria development by U.R. Committee and based on admission diagnosis and as-signs length of stay (LOS).
• Review each case daily after admission to adjust LOS if diagnosis has been changed.
• Review each case 2 days before assigned LOS expires to determine presence/absence of need for continued stay.
• Reviews all observation status patients with physician regarding continued treatment within 24 hours.
• Enters UR note service on each patient for precertification, concurrent, retro-active and other notes as needed.
• Scans/attaches facsimile confirmations, authorization letters, 1261A's and other documents as needed to appropriate service.
• Monitors all pending and current patient insurance status.
• Calls providers to obtain prior authorization status within 24 hours of admission.
• Complete concurrent reviews with providers as necessary.
• Refers any unclear cases to the Medical Director.
• Refers appropriate cases to U.R. Committee.
• Completes all appeals for denial authorization(s) as needed. (Refers for peer to peer or writes letter of intent to appeal with clinical support requesting authorization)
• Maintains an ongoing summary of all in-hospital Medicare patients.
• Ensures all Medicare recertification are completed by the Attending Physician on day 12, day 30 and every 30 days thereafter.
• Consults with physicians and treatment team re: continuation of treatment and insurance coverage.
• Works with billing office representative to ensure accurate authorizations for claims and retro-active stay coverage.
• Refers uninsured patients to Entitlement Specialist for appointment.
• Ensures patient has met with Entitlement Specialist if needed.
• Discontinues coverage according to Medicare guidelines.
• Issues written notices of disapproved continued hospital stay to appropriate cases.
• Performs liaison work as needed with Indiana medical Review Organization and commercial insurance.
• Serves on UR committee and prepares documents as needed to report to committee.
• Prepares weekly spreadsheet for Revenue Cycle Meeting.
• Keeps spreadsheet of needed retro-active authorization with current status.
• Enters authorization numbers and dates into patient file.
• Provides unit nursing coverage as needed. (may work up to a 12 hour shift as needed)
• Provides nurse on call coverage as needed.
• Participates in Hospital quality improvement program.
• Attends or completes all mandatory nursing requirements as available, including staff/nursing meetings.

We are seeking a Utilization Review Nurse candidate with the following qualities:

• Graduate of an accredited School of Nursing.
• Licensed as a Registered Nurse by the State of Indiana Health Professions Bureau.
• Previous inpatient psychiatric nursing experience desirable.
• Meets pre-hire competency and reference requirements.
• CPR Certification preferred.

Meridian Health Services provides Utilization Review Nurses the following benefits:

• Health, dental, vision plans
• $2,500 Welcome Bonus
• Merit Based Compensation Plans
• 401k with company contribution
• Voluntary benefits, including critical illness, short term disability, etc.
• Generous PTO plan
• Wellness plan
• Professional development funds
• Life balance oriented organization

Drug screen, TB test, extensive background check, and fingerprinting are required of all Meridian employees. Meridian Health Services recommends that all individuals who join Meridian have a flu shot and Covid vaccination to further protect our staff and the patients we serve. We also adhere to Covid-related protocol including wearing masks, social distancing, and sanitizing.

Meridian Health Services is an Equal Opportunity Employer (M/F/D/V) and also participates in E-Verify.

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