NICU Utilization Review Services RN

HCA Healthcare is one of the nation's leading providers of healthcare services with 190 hospitals and 2,400+ sites of care, including surgery centers, freestanding ERs, urgent care centers, home health and hospice agencies, and physician clinics, in 20 states and the United Kingdom. Every day, more than 316,000 colleagues go to work with a collective focus: our patients. Our focus positively impacts the care experience at the bedside and beyond. As a learning health system, HCA Healthcare analyzes data from more than 44 million patient encounters each year. This data helps develop technologies and best practices that improve patient care. We also share our learnings with the larger healthcare community and government agencies to improve care everywhere.

This position will focus on initial and continued to stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education, and Midas worklist rules. Maintain nursing licensure for assigned geographical market and productivity.

Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payor Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas Utilize critical thinking skills to review and apply medical necessity criteria • Proficient in the application and use of InterQual Analyze documentation of clinical care from the electronic medical record Exhibit determined and assertive verbal and written communication skills when interacting with payors Demonstrate knowledge and effective use of multiple applications, systems, and resources Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and Onbase Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies Practice adherence to HCA UR guidelines and practice standards Ability to work independently, show initiative, and work with minimal supervision in a work-from home environment