This position performs clinical reviews of medical records to assure compliance
with approved standards of care. Collects and maintains data, completes
internal and external reporting of data as required. Completes daily utilization
review activities in an acute care setting including chart reviews for
severity of illness and intensity of service criteria, and appropriate
communication with medical staff. Responsible for complying with certification
requirements with third party payers, discharge planning, and verification
of insurance benefits and requirements for inpatients and some outpatient
services. This person is also responsible for coordinating skilled care beds.
BLS, Graduate of an accredited school for Licensed Registered Nurses, and
Currently licensed in the State of Ohio are all requirements. Previous
experience in an acute care setting and experience in dealing with chart
review and regulatory standards required. BSN and experience with case
management and reimbursement related functions preferred.