RN UTILIZATION REVIEW SPECIALIST Per Diem

The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for all Medicare, AHCCCS, Self-pay, and all other payers, upon admission and concurrently throughout the admission. Reviews clinical documentation and facilitates modifications to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with regulations). Facilitates delivery of services to patients and families through effective utilization of available resources. Interfaces with Care Management team, physicians, case managers, payers, and others to provide quality outcome measurements and appeal denials.