Meridian Health Services logo

Utilization Review Nurse 6049

Meridian Health Services
On-site
West Lafayette, Indiana, United States

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.