Description

Job Description

Overview

Performs utilization review of inpatient admissions, outpatient surgeries, and ancillary services. Performs precertification, concurrent and retrospective reviews, and coordination of discharge planning. Determines medical necessity and appropriateness of services using clinical review criteria. Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum. Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care team to maintain high quality and cost effective care delivery.

• Requires an Associates of Nursing (ASN).
• Bachelors of Nursing (BSN) preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Requires that the RN has graduated from a nationally accredited nursing program.
• Requires 3-5 years of relevant experience.
• Basic Life Support certification through the AHA or other advanced life support certifications may be required per unit/department specialty according to patient care policies.
• Requires proficiency in Microsoft Office and applications.
• Requires understanding of medical record requirements, regulations and policies.

We are an equal opportunity employer. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.