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 patientsοΏ½ 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.