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This job is REMOTE.
FTE: 1.000000
Shift: Shift 1
Job Summary:
The RN Utilization Review Lead provides support to the Utilization Review (UR) team to ensure workflows and training support program goals and deliver efficient day-to-day operational outcomes. In collaboration with departmental leadership, physician advisors, and internal customers maintain standards in accordance with state, federal, and national regulations for accurate and ethical documentation capture to facilitate coding and billing. Participates in the design, implementation and evaluation of staff orientation, development, and continuing education related to Utilization Review (UR). Develops, analyzes, and monitors metrics to demonstrate UR program initiatives. Develops and maintains working relationships with hospital departments and team members.
EXPERIENCE DESCRIPTION:
Five (5) or more years acute care nursing experience, required. Two (2) or more years UR experience in an acute hospital setting, required. Utilization of Interqual, MCG care web QI or Indicia evidence-based guidelines, required.
EDUCATION DESCRIPTION:
Professional knowledge of nursing theory and practice at a level normally acquired through completion of a program at an accredited School of Nursing is required. Bachelor’s Degree in nursing is preferred.
SPECIAL SKILLS DESCRIPTION:
- Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission, working DRG, and some familiarity with hospital coding. Ability to read and correlate an extensive variety of medical / surgical medical treatments and monitoring to clinical conditions.
- Requires excellent observation, negotiation, verbal and written communication and presentation skills, analytical thinking, and problem-solving skills. Requires strong interpersonal skills including ability to interact with all levels of organization including executive leadership and develop strategies to present to senior leadership.
- Efficient use of MS Office products (Excel, Outlook, Word), WebEx and Epic (or similar EMR).
- Advanced knowledge of reporting, statistical principles, and processes.
- Expert knowledge payer trends and rules
- Expert knowledge of level of care guidelines
- Ability to document and maintain process documentation. Excellent follow-through from initiation to conclusion.
LICENSURE DESCRIPTION:
Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). MCG certification is required. Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
Compensation, Benefits & Perks at Froedtert Health
Pay is expected to be between: (expressed as hourly) $36.38 – $56.39. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
- Paid time off
- Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
- Academic Partnership with the Medical College of Wisconsin
- Referral bonuses
- Retirement plan – 403b
- Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available
The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin’s only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.